Business Title: Claims Adjuster I

Department:  Claims

Job Status: Full-time/Hourly 

Reports to:  Claims Team Lead

Amount of Travel: As needed

Work Schedule: Hybrid - 3 days in-office, 2 days remote after training

Pay: The expected hiring range for this position is from $21.69-27/hour plus additional bonus opportunity. The stated hiring range is based on experience, qualifications, and other relevant factors. Final compensation decisions will take into account a variety of considerations, including individual skills, internal equity, and organizational needs.

JOB SUMMARY

The Claims Adjuster I reviews claims related to property damage or loss. This position reports to the Claims Team Lead and works with various experts during the claims process to obtain accurate assessments and support in claims decisions. The Claims Adjuster I partners with Claims Trainer and Claims Team Lead to interpret the terms and conditions of insurance policies to determine coverage and exclusions applicable to each claim. This position also engages with policyholders to gather information, provide updates on the status of claims, and explain the claims process and decisions.  

JOB FUNCTIONS:

Claims Handling and Investigating 

• Maintains accurate and detailed notes regarding interactions, decisions, and actions taken throughout a claim. 

• Partners with Claims Team Lead and Trainers to review, evaluate, and investigate photos, estimates, forms, receipts, inspection reports, and official reports presented on a claim. 

• Reviews, partners, and processes property damage claims submitted by policyholders. 

• Reviews insurance policies to determine coverage by working with Claims Trainers and leadership to interpret and apply policy provisions to claims under consideration based on coverage and investigation findings. 

• Conducts, records, and interviews with those insured to secure information regarding personal loss. 

• Works with claimants or representatives of claimants (contractors, public adjusters, attorneys, or other legal representatives) to gather necessary information regarding the claim and to negotiate fair and equitable settlements, overseen by Claims Team Lead. 

• Collaborates with other insurance carriers as needed regarding duplicate claims and coverage. 

• Selects and assigns claims for inspections.
• Requests and issues settlement checks with explanation letters based on policy terms and investigation findings, with limited authority. 

• Prepares and issues denial letters to claimants, clearly outlining the reasons for denial based on policy terms and investigation findings.  

• Identifies potential fraudulent claims and refers for additional investigation as warranted. 

• Ensures claims handling complies with company and regulatory policies. 

• Escalates complex insurance claims to management and legal teams including those subject to complaints and litigation.  

• Consults with Claims Team Leads to resolve disagreements with a claim, utilizing alternative dispute resolutions (arbitration, appraisal, and mediation). 

• Collaborates with management on arbitration, appraisal, and mediations. 

• Maintains workflow to ensure timely processing of claims. 

• Partners with Claims leadership on difficult or unusual situations that arise on claims. 

• Prepares response letters to complaints or legal issues received. 

Customer Service 

• Provides excellent customer service by maintaining professional and constant dialogue with claimants in addition to handling claims promptly, efficiently, and with empathy.  

• Communicates regularly with policyholders or other relevant parties providing updates on the status of claims and addressing any questions or concerns.  

• Provides support to related teams during high work volume to meet or exceed established service levels.  

• Educates policyholders on the claim process and coverages by maintaining open communication throughout the claim duration. 

• Sorts and responds to incoming emails.

Training and Education  

• Assists with one-on-one training or job shadowing for new hires. 

• Completes required state continuing education requirements to maintain and renew adjuster license.

Other duties as assigned 

• This job description is not an exhaustive list of all the functions that a team member performs and other duties may be assigned.

QUALIFICATIONS:  

• Education: High School diploma or equivalent required, college degree preferred. 

• Experience: 0-2 years of related experience preferred.   

• Travel as needed. 

• Must have strong computer skills with ability to navigate Microsoft Office Suite. 

• Maintains excellent knowledge of state and federal laws and regulations. 

• Ability to communicate effectively and efficiently via phone, email, and person to person. 

• Capability of gathering facts accurately, analyzing causes, evaluating alternate solutions, and arriving at sound conclusions on action to be taken. 

• Ability to manage multiple and/or conflicting responsibilities. 

• Great attention to detail, organizational skills, and time management. 

• Good sense of urgency and follow up. 

• Ability to handle stressful situations. 

• Ability to work in a team environment. 

• Ability to make relatively complex decisions. 
• Licenses/Certifications: A current Property & Casualty Adjuster license preferred but not required. Must obtain license within 90 days of hire if not currently licensed and maintain state licensing requirements through the completion of continuing education when required by the state. 

KNOWLEDGE, SKILLS, AND ABILITIES (KSAs):   

• Must have strong computer skills with ability to navigate Microsoft Office Suite 

• Maintains excellent knowledge of state and federal laws and regulations 

• Claims experience helpful, working knowledge of AS/400 and basic understanding of insurance a plus 

• Ability to communicate effectively and efficiently via phone, email, and person to person 

• Capable of gathering facts accurately, analyze causes, evaluate alternate solutions, and arriving at sound conclusions on action to be taken 

• Ability to manage multiple and/or conflicting responsibilities 

• Great attention to detail, organizational skills, and time management  

• Good sense of urgency and follow up 

• Ability to handle stressful situations 

• Ability to work in a team environment 

• Capable of dealing with changes that can and will occur periodically 

• Ability to make complex decisions 

PHYSICAL DEMANDS: 

• Must be able to remain in a stationary position 75% of the time. 

• Will be constantly operating a computer and other office productivity machinery, such as a telephone, calculator, copy machine, and computer printer. 

• Will be communicating via phone, Teams, and Zoom. 

• Must be able to exchange accurate information at all times. 

• Must be able to identify and assess account status and determine appropriate process. 

• Will primarily work in a state-of-the-art indoor temperature controlled, sealed window office environment, while working a hybrid schedule.

Here are some more reasons to choose HomeFirst Agency!

• Full-time team members have the flexibility to create their own health, dental, and vision benefits package. HomeFirst Agency provides competitive 401(k) programs, including investment options and company matching for full and part time team members after one year to help our team members achieve their financial goals. Additional benefits include paid parental leave, tuition reimbursement, Employee Assistance Programs, and more.

• As part of HomeFirst’s commitment to Opening Doors to a Better Life, HFA is now providing paid time for Team Members to volunteer to causes that are meaningful to them through the Clayton Impact program.

• At HFA, we encourage holistic wellness with physical, nutritional, social, financial, spiritual, and occupational programs available online or in-person for team members.

• Our newly renovated Home Office campus offers an onsite restaurant, onsite fitness facility with full gym, in-person and virtual workout classes, yoga/barre studio, volleyball, and basketball courts, walking paths, and a disc golf course.

Clayton is committed to creating an inclusive workplace. HomeFirst Agency is an equal opportunity employer and does not discriminate on the basis of race, national origin, gender, gender identity, sexual orientation, protected veteran status, disability, age, or other legally protected status.

HomeFirst Agency. Where you start a job and gain a career!

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