California FAIR Plan Association

Claims Specialist

• Investigate, evaluate, and resolve property insurance claims.
• Adjust reserves and provide reserve recommendations.
• Enter claim transactions clearly and concisely.
• Examine claims inspected by independent adjusters, investigate questionable claims, verify coverage, and issue payments.
• Conduct daily diary reviews to ensure status letters are sent in accordance with Department of Insurance regulations.
• Pay and process claims within designated authority levels.
• Supervise independent adjusters for adherence to CFP IA Guidelines.
• Maintain compliance with Department of Insurance and company policies and procedures.
• Create accurate, complete correspondence and obtain missing information from policyholders and others.
• Negotiate settlements reflecting insured losses while protecting the insurer from invalid claims.
• Confer with Claims Management and legal counsel on litigated claims.
• Handle entire claims except inspection or specific coverages such as Personal Property or Fair Rental Value.
• Focus on claims over $300,000 in damages, while handling smaller claims when necessary.

Property Claims Examiner III

Business Analyst

• Evaluate claims business processes and identify opportunities to enhance efficiency, accuracy, and customer satisfaction.
• Conduct root cause analyses to uncover operational gaps, data inconsistencies, or process bottlenecks.
• Define and document “as-is” and “to-be” workflows using process mapping and related methodologies.
• Collaborate with business stakeholders to design improved end-to-end claims processes.
• Translate business needs into functional process requirements for automation, system enhancement, or workflow redesign.
• Work with the support partner vendor to implement fixes and enhancements to the Duck Creek Claims system.
• Document requirements, perform user acceptance testing and validation during release cycles for the claims system.
• Produce release notes and update the department as necessary on system changes.
• Develop, standardize, and maintain claims-related business processes, procedures, and performance metrics.
• Serve as a liaison between Claims and other departments to ensure process coherence, data alignment, and enhanced system capabilities, including Duck Creek and OnBase.
• Support Single Source of Truth initiatives ensuring consistent data usage, definitions, and reporting across systems.
• Define and track key performance indicators (KPIs) to measure process effectiveness and turnaround times.
• Prepare and present insights, findings, and process improvement recommendations to leadership.
• Support internal and external audits with accurate process documentation and data integrity assurance.
• Lead or participate in business process reengineering (BPR) and operational efficiency initiatives.
• Promote continuous improvement through feedback loops, metric-driven decision making, and proactive issue resolution.
• Perform other tasks required to support the Association’s Mission, Values, and Strategic Objectives.

Claims Business Process Analyst

Support Engineer

• Assist with the design, testing, and implementation of billing processes
• Perform user acceptance testing of billing functionality for system releases using predefined test plans and scripts
• Document testing results and communicate outcomes; perform follow-up testing as needed
• Investigate and resolve billing system discrepancies and errors
• Collaborate with other departments to ensure billing accuracy
• Ensure invoices reflect agreed terms and conditions and comply with Department of Insurance rules and regulations
• Identify and recommend improvements to billing policies and procedures
• Prepare and present analytical reports on trends, inefficiencies, delinquent accounts, and other metrics
• Monitor billing invoice and form generation cycles and alert management of failures
• Manage ad hoc customer billing and respond to customer billing inquiries
• Provide team-member coverage as needed
• Participate in cross-training initiatives
• Assist with analytical reports and run Billing SQL queries

Billing Technical Analyst I

Accounts Payable

• Support the day-to-day operations of accounts payable.
• Review purchase orders and statements, verify invoice amounts owed, and respond to vendor inquiries.
• Prepare, process, and post invoices timely and accurately.
• Reconcile financial accounts.
• Support month-end, quarter-end, and year-end close processes.
• Perform account analysis to identify and explain variances.
• Maintain documentation and supporting files, including approvals.
• Assist with internal and external audit requests.
• Liaise with the bank and other parties as required.
• Perform backup duties within the department.
• Record and process daily accounts payable transactions, obtain approvals, and issue checks.
• Assist with the accounts payable email queue and electronic file organization.
• Assist with printing daily premium refund checks and monthly commission checks.
• Assist with vendor maintenance in the general ledger, including payment locations and vendor request/change forms.
• Maintain current W-9 documents for accounts payable vendors.
• Research vendor payment discrepancies and respond to vendor inquiries.
• Assist with employee garnishment, broker garnishment, and broker backup withholding.
• Monitor company credit card transactions and required receipts.
• Assist with uploading disbursements.
• Respond to internal and external broker commission inquiries.

Property Claims Examiner III

Claims Business Process Analyst

Billing Technical Analyst I

Accounts Payable Clerk I