Description

• Receives assignments and reviews claim and policy information to provide background for investigations. May determine the extent of the policy's obligation to the insured, depending on the line of business.
• Contacts, interviews, and obtains statements (recorded or in person) from insured individuals, claimants, witnesses, medical professionals, legal representatives, law enforcement, and other relevant parties to gather necessary claim information.
• Depending on the line of business, may inspect and appraise damage for property losses or arrange for such appraisal.
• Evaluates facts obtained during investigations to determine the extent of liability and the company's obligation under the policy contract.
• Prepares reports on investigations, settlements, claim denials, and evaluations of involved parties.
• Sets reserves within authority limits and recommends reserve changes to the Team Leader.
• Reviews the progress and status of claims with the Team Leader, discussing challenges and recommending solutions.
• Prepares and submits to the Team Leader any unusual or potentially undesirable exposures.
• Assists the Team Leader in developing methods and improvements for handling claims.
• Resolves claims promptly and fairly.
• Obtains releases, proofs of loss, or compensation agreements and issues company drafts for claim payments.
• Communicates claim denials to claimants, insureds/customers, or attorneys as applicable.
• Manages litigation as required.