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Contact or interview claimants, doctors, medical specialists, or employers to get additional information.
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Report overpayments, underpayments, and other irregularities.
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Analyze information gathered by investigation and report findings and recommendations.
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Verify and analyze data used in settling claims to ensure that claims are valid and that settlements are made according to company practices and procedures.
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Prepare reports to be submitted to company's data processing department.
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Present cases and participate in their discussion at claim committee meetings.
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Confer with legal counsel on claims requiring litigation.
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Communicate with reinsurance brokers to obtain information necessary for processing claims.
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Review police reports, medical treatment records, medical bills, or physical property damage to determine the extent of liability.
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Resolve complex, severe exposure claims, using high service oriented file handling.
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Supervise claims adjusters to ensure that adjusters have followed proper methods.
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Obtain credit information from banks and other credit services.
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Attend mediations or trials.
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Maintain claim files, such as records of settled claims and an inventory of claims requiring detailed analysis.
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Investigate, evaluate, and settle claims, applying technical knowledge and human relations skills to effect fair and prompt disposal of cases and to contribute to a reduced loss ratio.
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Investigate and assess damage to property and create or review property damage estimates.
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Examine claims investigated by insurance adjusters, further investigating questionable claims to determine whether to authorize payments.
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Examine claims forms and other records to determine insurance coverage.
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Pay and process claims within designated authority level.
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Interview or correspond with agents and claimants to correct errors or omissions and to investigate questionable claims.
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Conduct detailed bill reviews to implement sound litigation management and expense control.
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Adjust reserves or provide reserve recommendations to ensure that reserve activities are consistent with corporate policies.
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Refer questionable claims to investigator or claims adjuster for investigation or settlement.
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Negotiate claim settlements or recommend litigation when settlement cannot be negotiated.
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Enter claim payments, reserves and new claims on computer system, inputting concise yet sufficient file documentation.
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Collect evidence to support contested claims in court.
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Communicate with former associates to verify employment record or to obtain background information regarding persons or businesses applying for credit.
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Interview or correspond with claimants, witnesses, police, physicians, or other relevant parties to determine claim settlement, denial, or review.
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Examine titles to property to determine validity and act as company agent in transactions with property owners.