Description

• Determine coverage, conduct thorough investigations, and assess the extent of policy obligations based on the line of business.
• Maintain a diary system to ensure each file is reviewed at least every 90 days.
• Collaborate effectively with defense counsel and litigation teams, as directed by the client.
• Prepare detailed 90-day Claim Summary Reports and provide updates to clients on investigations, settlement opportunities, claim denials, reservation of rights, third-party tenders, and recommendations for claims review meetings.
• Post loss and expense reserves in the claims system within authority limits; recommend reserve changes above authority to AVP and/or VP of Claims.
• Review claim progress and status with claims leadership, discussing issues, opportunities, tasks, and remedial actions.
• Submit to claims leadership any unusual or potentially undesirable exposures, such as allegations of bad faith or unfair claim practices.
• Assist claims leadership in developing improvements to claims handling procedures.
• Work with Partnership Leaders to deliver results, attend meetings, and participate in claim reviews.
• Review and confirm that claims professionals have secured appropriate releases, proofs of loss, or compensation agreements, and issue payments for claims.
• Maintain claims files with accurate notes, reports, photos, and documentation.
• Adhere to all company and regulatory compliance requirements.
• Update claims promptly with Medicare data and address Medicare reporting and interests.
• Meet or exceed performance goals.