Description

• Receive and review new claim assignments.
• Analyze claim and policy information to provide background for investigations and determine the extent of policy obligations.
• Contact, interview, and obtain statements (recorded or in person) from insureds, claimants, witnesses, physicians, attorneys, police officers, and other relevant parties to gather necessary claim information.
• Arrange for surveys and engage experts as appropriate.
• Evaluate facts obtained during investigations to determine liability and the company's obligations under the policy contract.
• Prepare reports on investigations, settlements, denials, and evaluations of involved parties.
• Set reserves within authority limits and recommend reserve changes to the Team Leader as needed.
• Review claim progress and status with the Team Leader, discussing challenges and recommending solutions.
• Manage litigation files in a timely and appropriate manner.
• Assist the Team Leader in developing methods and improvements for claim handling.
• Settle claims promptly and equitably.
• Obtain releases, proofs of loss, or compensation agreements and issue company payments for claims and related expenses.
• Inform claimants, insureds, agents, 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 resolve claims before trial.
• Refer claims to subrogation when appropriate.
• Participate in claim file reviews and audits with customers, insureds, and brokers as needed.
• Administer benefits in a timely and appropriate manner, maintaining control of the claim resolution process to minimize current and future exposure.
• Establish and maintain strong relationships with customers, agents, underwriters, and experts.

• Maintaining system logs.
• Investigating compensability and benefit entitlement.
• Reviewing and approving medical bill payments or forwarding for external review as necessary.
• Managing vocational rehabilitation.