Commercial Claims Examiner

This position is listed on behalf of a partner company, who manages all applications and next steps. Our partner is looking for a Commercial Claims Examiner III based in the United States.

The Commercial Claims Examiner III is responsible for evaluating, investigating, and resolving complex commercial property insurance claims, with a primary focus on high-value losses exceeding $500,000. This role involves reviewing coverage, assessing claim validity, managing reserves, and authorizing payments and settlement recommendations. Working closely with independent adjusters, internal teams, and legal counsel, the examiner ensures claims are handled accurately, fairly, and efficiently. The position requires strong technical expertise in commercial property policies, claims procedures, and settlement practices. It also involves identifying potential fraud, maintaining regulatory compliance, and negotiating settlements that reflect covered losses while protecting the insurer’s interests. This is a full-time remote opportunity for an experienced claims professional based in the United States.

Accountabilities

• Manage a portfolio of commercial property claims from initial assignment through final resolution, primarily handling claims exceeding $500,000.
• Review claims investigated by independent adjusters to assess coverage, verify claim validity, and determine appropriate resolutions.
• Evaluate and adjust loss reserves, review correspondence and reports, verify policy coverage, and authorize payment requests and recommendations submitted by independent adjusters.
• Investigate, assess, and adjust claims using technical expertise and strong interpersonal skills to support fair and timely settlements.
• Collaborate with internal stakeholders and legal counsel on claims involving litigation.
• Monitor independent adjuster files to ensure compliance with applicable guidelines and claims-handling standards.
• Analyze settlement data and supporting documentation to confirm the accuracy and validity of claims and ensure settlements follow established procedures.
• Maintain compliance with Department of Insurance requirements and internal claims procedures.
• Identify potential indicators of fraud or illegal activity and refer cases through the appropriate internal processes.
• Negotiate settlements promptly, ensuring that payments reflect covered losses while protecting the insurer from invalid claims.

Requirements

• Bachelor’s degree or equivalent.
• At least 5 years of property claims adjusting experience, including preferably 2 or more years in commercial property claims.
• Four years of commercial claims experience, including 2 years handling claims exceeding $500,000.
• Comprehensive understanding of insurance policy contracts, applicable statutes, and claims processes.
• Certification in CEA and Fair Claims Settlement Practices.
• Strong written and verbal communication skills, with the ability to collaborate effectively with adjusters, legal counsel, and internal stakeholders.
• Working knowledge of Microsoft Office, particularly Word and Excel.
• Strong analytical, investigative, negotiation, and decision-making skills, with the ability to evaluate complex claims and recommend appropriate settlements.

Benefits

• Compensation: $46.15–$51.28; the source does not specify the pay period or currency.
• Work arrangement: Remote.
• Employment type: Full-time.