Description

• Receive and manage claim assignments.
• Review claim and policy information to provide context for investigations and determine the extent of policy obligations, depending on the line of business.
• Contact, interview, and obtain statements from insured parties, claimants, witnesses, medical professionals, attorneys, police officers, and others to secure necessary claim information.
• Inspect and appraise property damage or arrange for appraisal, as required by the line of business.
• Evaluate investigation findings to determine liability and the company's obligations under policy contracts.
• Prepare reports on investigations, settlements, claim denials, and evaluations of involved parties.
• Set reserves within authority limits and recommend reserve changes to the Team Leader.
• Review claim progress and status with the Team Leader, discussing challenges and recommending solutions.
• Submit unusual or potentially undesirable exposures to the Team Leader and assist in developing improved claim handling methods.
• Resolve claims promptly and equitably.
• Obtain releases, proofs of loss, or compensation agreements and issue payments for claims.
• Inform claimants, insured parties, or attorneys of claim denials when applicable.
• Assist the Team Leader and company attorneys in preparing cases for trial, including arranging witness attendance and taking statements, while continuing efforts to settle claims before trial.
• Refer claims to subrogation as appropriate and arrange for salvage disposition or other recovery proceedings as needed.
• Participate in claim file reviews and audits with customers, insured parties, and brokers.
• Administer benefits in a timely and appropriate manner, maintaining control of the claim resolution process to minimize exposure and future risks.
• Establish and maintain strong customer relationships.

• Maintaining system logs
• Investigating compensability and benefit entitlement
• Reviewing and approving medical bill payments
• Managing vocational rehabilitation