Claims Appeals Examiner

Optimal Solutions & Technologies (OST, Inc.) is focused on excellence. We specialize in providing Management Consulting, Information Technology, and Research Development and Engineering services.

The fundamental distinction of the OST team is its business knowledge in both the public and private sectors. We serve the aerospace & transportation, association & nonprofit, defense, education, energy, financial, healthcare, and technology & telecommunications industries. OST is successful because we listen to our clients, we learn from our clients, and we know our clients.

Claims Appeals Examiner

Description of specific duties in a typical workday for this position:

• Core responsibilities focus on the daily processing and adjudication of claims appeals for the National Flood Insurance Program (NFIP).
• Research, analyze, and evaluate claims appeal case files and supporting documentation; formulate conclusions and prepare clear, well-reasoned written determinations in letter or narrative form for policyholder appeals
• Track, report, and communicate appeal status, risks, and issues in accordance with client requirements
• Assist in the preparation, review, and delivery of claims appeals reports and required program deliverables
• Support disaster response activities, including the preparation of time-sensitive and mission-critical reports
• Produce high-quality, accurate documentation and analytical reports
• Identify, document, and escalate risks within assigned areas of responsibility
• Complete all mandatory OST and project-required training
• Coordinate and communicate with FEMA personnel and insurance industry stakeholders regarding policyholder appeals
• Maintain timely, accurate case notes and data within the system of record, updating daily as required
• Perform quality control reviews as assigned to ensure compliance and accuracy
• Maintain awareness of current NFIP policies, procedures, and program updates
• Support team operations as needed, including cross-training to ensure continuity of operations

Requirements (Years of experience, Education, Certifications):

• Candidates must meet or exceed each of the following minimum qualifications:
• Bachelor's degree required
• Minimum of 5 years of successful claims-handling experience at a Property & Casualty insurance company
• Strong analytical and problem-solving skills with close attention to detail
• Excellent written and verbal communication skills
• Proficiency in Microsoft Office, particularly Excel, Word, and PowerPoint
• Ability to learn and apply new skills through OST-provided training
• S. citizenship required
• Ability to obtain and maintain a Public Trust security clearance
  
  
  
  • Must be able to complete EOD high
  
  
  
  

Nice to Have (skills that are not required, but nice to have):

• Prior experience with the National Flood Insurance Program (NFIP)or flood insurance industry
• Claims experience as an adjuster, examiner, or in direct support of those roles
• Experience producing reports and analyses using Excel
• Familiarity with underwriting processes
• Coursework in business, economics, or a related field

This is a full-time position paying a base salary of $75,000, full benefits, and has possible bonus potential based on merit and performance. To be considered for this position, please apply online with a resume.

OST is an equal opportunity employer. Applicants are considered for positions without regard to race, religion, gender, native origin, age, disability, or any other category protected by applicable federal, state, or local laws.