Claims File Reviewer / Auditor Location

# Claims File Reviewer / Auditor

## About This Role

We are a licensed public adjusting firm and roofing company based in Chicagoland, Illinois, and indiana, that represents homeowners against insurance companies. When a homeowner has property damage (hail, wind, ), the insurance company sends their own adjuster to write an estimate. Our job is to review that estimate, find everything the carrier missed or underpaid, and fight to get the insured the full amount they are owed under their policy.

The File Reviewer is the person who keeps every active claim file moving forward and makes sure nothing falls through the cracks. You will review insurance policies, audit damage estimates, compare photos against scopes of work, draft follow-up emails to insurance carriers looking for policy's and missed scopes, and prepare damage summaries photo reports, that support our negotiations.

You will be trained on insurance terminology, property damage identification, and claim file strategy. You need to be sharp, detail-oriented, and comfortable learning a technical subject matter.

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## What You Will Do Every Day

### 1. Policy Review & Coverage Analysis

You will open the insured's insurance policy and pull out the information that matters for the claim. This includes:

- Coverage limits (how much the policy will pay for dwelling, other structures, personal property, loss of use)
- Whether the policy pays Replacement Cost or Actual Cash Value
- Endorsements that increase coverage (extended replacement cost, ordinance or law, water backup)
- Sublimits or exclusions the carrier might use to reduce or deny parts of the claim
- Confirm the date of loss falls within the policy period
- Identify the deductible amount and type (flat dollar vs. percentage-based wind/hail deductible)

**Example:** A homeowner's HO-3 policy shows Coverage A (Dwelling) at $350,000 with a replacement cost provision and a 25% extended replacement cost endorsement. You confirm this means up to $437,500 is available for dwelling repairs. You also flag an ordinance or law endorsement that covers code upgrade costs, which the carrier has not addressed in their estimate.

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### 2. File Auditing: Scope Comparison & Missed Damage Identification

This is the most critical part of the role. You will compare the insurance carrier's estimate against our internal scope and the inspection photos, line by line, looking for anything the carrier missed, excluded, or underpriced.

**What you are looking for:**

**Roof:**
- Carrier replaces the main roof field but omits ridge cap shingles or ridge vent replacement
- Missing starter strip, drip edge, ice and water shield, or other code-required items
- Pipe boots, step flashing, counter flashing, and chimney flashing visible as damaged in photos but not included in the carrier's scope
- Ventilation upgrades required by current building code but excluded from the estimate

**Siding:**
- Carrier scopes partial siding repair on one elevation, but photos show hail impact damage across multiple elevations
- Vinyl or aluminum siding where a full elevation or full house replacement is required to achieve a uniform appearance and restore the property in a workmanlike manner
- Carrier prices "patch repair" when the damage pattern across multiple elevations requires full replacement

**Window Wraps / Capping:**
- Aluminum window and door trim wraps showing denting, creasing, or paint chipping from hail
- Carriers routinely exclude these entirely or price them as "touch-up paint" instead of full re-wrap
- Check every window and door on every elevation against the photos

**Gutters & Downspouts:**
- Denting and bruising visible in photos but carrier only included one or two sections
- Check all elevations for gutter damage
- Confirm downspouts, elbows, splash blocks, and gutter screens are all accounted for

**Soffit & Fascia:**
- Hail or wind damage to aluminum soffit panels and fascia wrap
- These are frequently visible in photos but completely missing from the carrier's scope

**Paint / Stain:**
- Interior or exterior surfaces that need repaint after repairs
- Carrier may include repair of a ceiling or wall but exclude the paint needed to finish the job
- Exterior surfaces requiring full repaint to maintain a uniform appearance after partial replacement

**Interior Damages:**
- Water stains on ceilings or walls visible in photos that indicate water intrusion from roof damage
- No interior line items in the carrier's scope despite visible evidence of interior water damage
- Check kitchen, bathroom, bedroom, and hallway ceiling/wall photos for staining or water marks

**Overhead & Profit (O&P):**
- When three or more trades are involved in the repair (roofing, siding, gutters, interior, paint, etc.), general contractor overhead and profit should be included
- Flag every file where the scope involves multiple trades but O&P has been excluded

**Code Upgrades:**
- Drip edge, ice and water shield, starter strip, ventilation, and other items required by current building code that the carrier has not included
- These are owed under ordinance or law coverage and are frequently left out of carrier estimates

**Example:** The carrier's Xactimate estimate includes roof replacement on two slopes and one elevation of siding. Inspection photos show hail impacts on siding across three additional elevations, dented window wraps on eight windows, crushed gutter sections on the north and west elevations, and a water stain on the master bedroom ceiling. None of these appear in the carrier's scope. You flag each missed item with the corresponding photo reference and prepare a list for the supplement demand.

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### 3. Damage Report Preparation

You will review inspection photos and field notes to prepare written damage summaries. These summaries describe what damage is present, what caused it, and what repairs are needed to restore the property to its pre-loss condition.

These reports are used to support supplement requests, appraisal demands, and carrier negotiations. They need to be clear, specific, and professional.

**Example:** Field photos show granule displacement and fracturing on three-tab shingles across all roof slopes, bruising on aluminum gutters, and dented drip edge. You prepare a summary documenting each damaged component, the number of affected slopes, the hail impact pattern, and why a full roof replacement (not spot repair) is required to restore the roof in a workmanlike manner.

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### 4. Outbound Correspondence & Follow-Up

You will draft and send status emails to insurance carriers requesting:

- Claim status updates
- Adjuster assignments and inspection scheduling
- Estimate releases and coverage determinations
- Payment status and check issuance
- Responses to our supplement requests

You will track response timelines and flag files where carriers have gone silent or are approaching regulatory response deadlines. No file should sit idle without a follow-up on the calendar.

**Example:** A State Farm field adjuster inspected a property three weeks ago but no estimate has been released. You send a follow-up email referencing the inspection date, requesting the estimate and any coverage determination, and noting the elapsed time since inspection.

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### 5. CRM Documentation

You will log all file activity in the CRM with clear notes. Notes should summarize what was reviewed, what was found, and what action is needed next. Every note tags the admin team so nothing gets lost.

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## Tools You Will Use

- **CRM / Claims Management System** (you will be trained on our system)
- **Xactimate** or **Xactimate Reports** (insurance estimating software; you will learn to read and compare these)
- **Google Workspace** (Gmail, Drive, Docs, Sheets)
- **PDF Viewers** for policies, inspection reports, and carrier correspondence
- **Photo Management** for reviewing property damage documentation

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## This Role Is a Good Fit If You...

- Are extremely detail-oriented; you catch things other people miss
- Can learn a new industry quickly; you will be trained on insurance claims, but you need to absorb and retain technical information
- Are comfortable working independently and managing a queue of 20 to 50+ active files
- Can write clear, professional emails in English
- Are organized and proactive; you follow up without being told to follow up
- Have experience in insurance, claims, restoration, or construction (a strong plus, but not required if you are a fast learner)
- Can compare two documents side by side and spot the differences
- Are comfortable reviewing property damage photos (roofs, siding, gutters, interiors) and learning to identify damage types

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## What You Will NOT Be Doing

- You will NOT be making phone calls (this is an email and documentation role)
- You will NOT be in the field inspecting properties
- You will NOT be writing Xactimate estimates from scratch (you are reviewing and comparing existing estimates)
- You will NOT be providing legal advice or making strategic claim decisions (that is the principal's role)

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## Schedule & Compensation

- Full-time position (40 hours per week)
- Compensation commensurate with experience
- Paid via Wise
- Must be available during US business hours (Central Time) for overlap and communication
- Long-term position with growth potential as you develop insurance expertise
- Speaks and writes in english

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## How to Apply

Send a message that includes:

1. A brief summary of your relevant experience (insurance, claims, admin, document review, or similar detail-oriented roles)
2. Describe a time you caught an error or found something that was missed in a document, report, or process
3. Confirm your availability and that you can work during US Central Time business hours