Claims Examiner

Atlantic Casualty Insurance Company (ACIC) is a recognized Excess and Surplus Lines carrier and proud affiliate of the Auto-Owners Insurance Group since 2016. With authority in all 50 states and Washington, D.C., ACIC provides innovative insurance solutions while maintaining a strong financial foundation, reflected in our A.M. Best rating of A (Superior).

Our strength comes from our people. For six consecutive years, we've been certified a Great Place to Work and consistently ranked among Fortune’s “100 Best Small and Medium Workplaces”. At ACIC, we foster a culture where everyone belongs. We’re a team—supporting one another through leadership development, mentorship programs, career certifications, and comprehensive benefits.

Our benefits include:

• Health, Dental & Vision plans (HSA & PPO options)
• 401(k) with company match financial advisor access
• Tuition reimbursement & student loan assistance
• Paid parental leave
• Counseling and mental wellness support
• Flexible work and in-office schedules

Whether you're just starting your career or looking to grow it, Atlantic Casualty is where talent thrives, and teamwork drives success.

Please visit our Careers Page for more information on the benefits and programs you will enjoy by joining the team at Atlantic Casualty Insurance Company.

www.atlanticcasualty.net/about-acic/our-careers/

About the Role:

As a Claims Examiner, you will play a critical role in the insurance process by thoroughly reviewing and evaluating insurance claims to determine their validity and ensure compliance with policy terms. Your work will directly impact the accuracy and fairness of claim settlements, helping to protect the financial interests of both the insurance company and its clients. You will analyze detailed documentation, investigate claim circumstances, and collaborate with various stakeholders to resolve discrepancies or disputes. This position requires a keen eye for detail, strong analytical skills, and the ability to make sound decisions based on complex information. Ultimately, your efforts will contribute to maintaining the integrity and efficiency of the claims process within the organization.

Skills:

In this role, your analytical skills will be essential for evaluating claim details and identifying inconsistencies or potential fraud. Strong communication skills will enable you to interact effectively with claimants and internal teams, ensuring clear and professional exchanges. Your organizational abilities will help you manage multiple claims simultaneously while maintaining accuracy and meeting deadlines. Proficiency with claims management software and data analysis tools will support efficient processing and documentation of claims. Additionally, your knowledge of insurance policies and regulations will guide your decision-making to ensure compliance and fair outcomes.

Minimum Qualifications:

• High school diploma or equivalent; associate or bachelor’s degree in a related field preferred.
• At least 2 years of experience in insurance claims processing, examination, or a related role.
• Strong understanding of insurance policies, claims procedures, and relevant regulatory requirements.
• Proficiency in using claims management software and standard office productivity tools.
• Excellent analytical, organizational, and communication skills.

Preferred Qualifications:

• Certification such as AIC (Associate in Claims) or CPCU (Chartered Property Casualty Underwriter).
• Experience with specific types of insurance claims such as health, auto, or property insurance.
• Familiarity with legal terminology and procedures related to insurance claims.
• Demonstrated ability to handle complex or high-value claims effectively.
• Advanced skills in data analysis and reporting.

Responsibilities:

• Review and assess insurance claims for accuracy, completeness, and compliance with policy guidelines.
• Investigate claims by gathering and analyzing relevant information, including medical records, police reports, and witness statements.
• Determine the legitimacy of claims and recommend approval, denial, or further investigation as appropriate.
• Communicate with claimants, healthcare providers, and other parties to clarify information and resolve issues.
• Document findings and decisions thoroughly in the claims management system to ensure transparency and audit readiness.
• Collaborate with legal, underwriting, and fraud prevention teams when necessary to address complex or suspicious claims.
• Stay current with industry regulations, company policies, and best practices to ensure compliance and quality standards.