Claims Examiner II

California FAIR Plan Association

. Process insurance claims for property losses based on coverage, appraisal, and verifiable damage.

Posted 10/26/2026full-timeRemote • California • United StatesMid-LevelSenior💰 $41 - $46 per hourWebsite

Core Competencies

Role fit

Core Competencies

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Demonstrates expertise in processing insurance claims, including evaluating coverage, negotiating settlements, and maintaining compliance with regulatory standards. Proficient in managing claims transactions and providing clear communication to policyholders and stakeholders.

Highest-signal resume keywords

Property Claims ExperienceFair Claims Settlement Practices CertificationMS-Office ProficiencyCustomer Service ExcellenceClaims Management

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Insurance Claims ProcessingClaims InvestigationPayment RecommendationsClaims EvaluationReserve Recommendations

Soft Skills

Excellent Oral CommunicationExcellent Written Communication

Tools & Technologies

MS-OfficeClaims Management Software

Certifications & Qualifications

CEA CertificationFair Claims Settlement Practices Certification

Industry Keywords

Department of Insurance ComplianceIndependent AdjustersClaims SettlementHO ClaimsCFP IA Guidelines

About the role

Key responsibilities & impact

Process insurance claims for property losses based on coverage, appraisal, and verifiable damage.
Interact with independent adjusters and policy holders.
Review claim forms and other records to determine insurance coverage.
Make payment recommendations and settlements in accordance with company practices, procedures, and Fair Claims Settlement Practices regulations.
Investigate, evaluate, and resolve claims.
Adjust reserves and provide reserve recommendations.
Enter claim transactions clearly and concisely.
Examine claims inspected by independent adjusters, including further investigation of questionable claims and verification of coverage.
Conduct daily diary reviews on claim files and ensure status letters are sent in accordance with Department of Insurance regulations.
Pay and process claims within designated authority level.
Supervise independent adjusters to ensure adherence to CFP IA Guidelines.
Maintain compliance with Department of Insurance and company policies and procedures.
Create accurate and complete correspondence to policyholders and secure missing information.
Negotiate settlements reflecting actual insured losses while protecting the insurer from invalid claims.
Confer with Claims Management and legal counsel on claims involving litigation.
Handle the entire claim except inspection, or a specific coverage such as Personal Property or Fair Rental Value.
Handle claims generally ranging from $100,000 to $300,000 in damages, with larger or smaller claims as necessary.

Requirements

What you’ll need

Minimum bachelor’s degree or equivalent preferred.
Excellent oral and written communication skills.
Working experience with MS-Office (especially Word and Excel) is required.
2+ years property claims experience and excellent customer service.
Certified in CEA and Fair Claims Settlement Practices.
3 years total claims experience, 2 years handling HO claims up to $300,000.
1 year Carrier Experience Required.