Claims Examiner

Job Description

Title : Claims Adjudication

Location : Chesapeake, VA

Duration : 24-month contract

As a Claims Adjuster – Technical Adjudication, you will handle and adjudicate complex insurance claims, ensuring fair and accurate claim resolutions in compliance with company policies, regulatory requirements, and service standards. You will be responsible for managing end-to-end claims processes, investigating claim facts, determining coverage, assessing liability, negotiating settlements, and maintaining strong relationships with members while delivering commitment to service excellence.

Key Responsibilities

• Review, analyze, and adjudicate assigned claims (auto, property, casualty, or specialty lines) with technical accuracy and efficiency.
• Evaluate coverage, liability, and damages to determine appropriate claim outcomes.
• Investigate claims through interviews, document review, and coordination with third-party vendors or field adjusters.
• Ensure claims decisions comply with state regulations, guidelines, and best practices.
• Negotiate settlements and manage reserve and payment authority within company limits.
• Maintain detailed documentation of claim activities and communications.
• Identify potential fraud indicators and refer as appropriate.
• Collaborate with internal partners (legal, underwriting, SIU, etc.) to ensure comprehensive resolution.
• Support process improvement initiatives and mentor junior adjusters as needed.

Required Skills & Qualifications

Preferred Skills