Insurance Claims Specialist

Responsibilities

• Claims Review and Analysis
• Review residential property damage reports, adjuster reports, inspection findings, photographs, and repair estimates.
• Validate that claim payments are consistent with documented damages and approved scope of repairs.
• Compare adjuster assessments against contractor estimates and settlement amounts.
• Identify discrepancies, payment variances, duplicate charges, scope inconsistencies, and potential overpayments or underpayments.
• Ensure claims are processed in accordance with company guidelines, investor requirements, and applicable regulations.
• Escalate questionable claims, exceptions, or potential fraud indicators to management and appropriate stakeholders.
• Claims Quality Control
• Perform detailed quality assurance reviews of completed claims files.
• Verify supporting documentation is complete, accurate, and properly retained.
• Monitor claim trends, recurring issues, and process deficiencies.
• Recommend process improvements to enhance claim accuracy and operational efficiency.
• Support internal and external audit requests related to hazard claims activities.
• Reporting and Analytics
• Develop, maintain, and distribute claim tracking reports and dashboards.
• Monitor claim lifecycle metrics, payment trends, vendor performance, and exception reporting.
• Analyze claim data to identify operational risks and opportunities for process improvement.
• Prepare management reports summarizing claim review outcomes, payment accuracy, and performance metrics.
• Utilize Excel, reporting tools, and claims systems to track key performance indicators (KPIs).
• Vendor Management
• Coordinate with adjusters, inspectors, contractors, restoration companies, and other third-party vendors.
• Review vendor estimates and supporting documentation for reasonableness and accuracy.
• Monitor vendor performance against service-level agreements and quality standards.
• Resolve documentation deficiencies and payment-related discrepancies with vendors.
• Facilitate communication between vendors and internal business units to ensure timely claim resolution.
• Stakeholder Collaboration
• Partner with Claims, Loss Draft, Risk Management, Loan Servicing, Quality Assurance, and Compliance teams.
• Communicate claim review findings and recommendations to management.
• Support process improvement initiatives and special projects.
• Assist with training efforts related to claim review standards and best practices.

Requirements

• Education
• Bachelor's degree in Business, Insurance, Risk Management, Finance, Construction Management, or related field preferred.
• Equivalent combination of education and experience may be considered.
• 3+ years of experience in property insurance claims, hazard claims, loss draft administration, property inspection review, mortgage servicing, or related field.
• Experience reviewing residential property damage assessments and insurance claim settlements.
• Familiarity with adjuster reports, repair estimates, contractor bids, and property restoration processes.
• Knowledge and Skills
• Strong understanding of residential property insurance claims and damage assessment.
• Knowledge of roofing, structural, water, fire, wind, hail, and disaster-related property damages.
• Ability to analyze claim documentation and identify inconsistencies.
• Advanced proficiency in Microsoft Excel, including pivot tables, reporting, and data analysis.
• Strong analytical, problem-solving, and decision-making skills.
• Excellent written and verbal communication skills.
• Experience with claims management systems and reporting platforms preferred.
• Ability to manage multiple priorities in a fast-paced environment.
• Property and Casualty (P&C) insurance experience.
• Adjuster license or insurance certification preferred.
• Experience in m

Additional Information

Selene Holdings is a multiple-lines business financial services firm with a mortgage servicing company, a loan diligence company, a title company, an insurance brokerage, and a real estate owned company. We have office locations in Dallas, TX, Jacksonville, FL, and Salt Lake City, UT. Founded in 2007 to address needs in the mortgage industry, Selene strives to provide amazing client and borrower experiences. A positive attitude coupled with proven creative thinking and actions are all attributes we seek in every one of our employees. If you want to make a difference, then Selene is the place for you! The Hazard Claims Review Specialist is responsible for reviewing residential property damage claims to ensure claim payments accurately align with documented damages, policy coverage, adjuster findings, and repair estimates. This role analyzes damage reports, adjuster inspections, contractor estimates, and claim settlements to identify discrepancies, overpayments, underpayments, or potential compliance issues. The specialist develops tracking and reporting tools, collaborates with internal stakeholders and third-party vendors, and supports quality assurance efforts across the hazard claims process.

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