Claims Bodily Injury Examiner

San Diego, California
Sep 07, 2016
Oct 21, 2016
Job Type
Full Time

As an experienced Bodily Injury Liability Claims Examiner you will play a critical role by being part of our claims team that focus on delivering an empathetic voice and provide exceptional customer service by achieving a prompt, fair and equitable settlement according to fair claims handling requirements.  In this role, you will investigate, evaluate and negotiate claims of varying complexity.  This includes knowledge of policy contracts, investigation, and determination of coverage, liability and damages, and the setting of proper reserves.   This also includes the ability to investigate, evaluate and negotiate bodily injury claims with both attorney represented claimants as well as claimants without attorney representation.

Duties and Responsibilities:

  • Empathize and assist our customers that have been involved in an auto accident.
  • Evaluate losses utilizing critical thinking and solid judgment to solve problems, make decisions and resolve complex issues inherent in handling claims by using the claim report, the insurance policy and administers applicable state statues in accordance with established company guidelines.
  • Conducts a prompt, thorough and fair investigation by obtaining relevant facts to determine coverage, origin and extent of loss.
  • Engages and manages with parties involved in the claims process by determining facts, causation, damages and exposure; monitors costs to endure they are reasonable and necessary.
  • Keeps the insured and others informed about the claims status with patience, clarity, timely and accurate written/verbal communications to resolve claims efficiently and effectively.
  • Confirms or denies coverage of the claim based on the facts and the policy terms and conditions.
  • Develops information necessary to make advance, partial and final payments when appropriate.
  • Effectively negotiates the settlement of claims of varying complexity with little direction and more complex claims under the direction of their supervisor/manager.
  • Achieves a prompt, fair and equitable settlement of a claim, where there is policy liability.
  • Maintains a diary system for file review and document files to reflect status of work being performed on the file.
  • Documents and communicates all claims activities timely and effectively and in a manner which supports the outcome of the claims file
  • Other duties as assigned by Supervisor/Manager.


  • Bachelor’s degree in related field from a four year college or university preferred.
  • Two or more years of related experience preferred in automobile claims handling.
  • Knowledge of automobile claims, coverage evaluation, claims investigation, loss assessment, evaluation and reserves, insurance regulation, negotiation and settlement
  • Extensive knowledge of investigation management including but not limited to taking and using recorded statements, determining coverage and application of coverage to claims, negotiation and resolution of claims.
  • Knowledge or medical terminology and the ability to understand and accurately interpret medical records, billing and bill coding.
  • Technical knowledge of California and/or Arizona specific adjusting issues including regulatory compliance, relevant case law and legal framework.
  • Texas, Washington, and Oregon claims knowledge a plus.
  • Self directed individual who works well with the minimal supervision.
  • Must have strong analytical skills necessary to make decisions, resolve issues inherent in handling claims effectively by dealing with situations at various levels of intensity and reach a resolution.
  • Must be able to interpret insurance policies and various contracts, perform analytical research and make sound decisions using good judgment.
  • Interpersonal skills and ability to work with all levels of the organization.
  • Ability to effectively operate a computer and have working knowledge of MS Office applications.