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claims adjuster

  • Draft reports to our principle summarizing underlying policy coverage, liability recommendations, litigation updates, injury evaluations, and indemnity payment requests. 
  • Negotiate claim settlements and recommend litigation when settlement cannot be negotiated.above the principle’s file handling standard
  • Attend arbitrations, mediations, depositions, and other court-mandated conferences during the claim litigation process. 
  • Obtain relevant evidence and information regarding suspicious claims. 
  • Consistently help maintain a file audit result 
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claims adjuster

  • Responsible for handling claims investigation from beginning to end.
  • This process includes coverage determination, taking recorded statements and 24 hour contact requirements.
  • Evaluate and negotiate settlements which may include denial of claims due to no coverage or where no liability exists.
  • Establish and maintain proper reserves throughtout the lifetime of the claim file.
  • Responsible for maintaing diary schedule for all claims in adjusters care.
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claims adjuster

  • Adjudicate and process Claims within the agreed company SLA – clear to zero, in accordance with policy benefits to facilitate the company achieving its loss ratio target.
  • Operate within and meet the conditions of company service standards, clear to zero, to guarantee customer satisfaction and retention.
  • Management of client’s medical cases according to service-level agreements (Underwritten cases as well as Groups).
  • Responsibility for complex VIP client group.
  • Exceeding productivity and quality targets inc.
  • Personal, team and departmental targets.
  • Development of Microsoft Excel-based tracking system for difficult claims.
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claims adjuster

  • Handling auto and property damage claims working with computer programs such as Audatex and xactimate estimating systems, etc.   
  • Use AWC’s client database, Gulliver, accurately and effectively.
  • Cost containment, identifying duplicate payments, possible non-disclosure and fraudulent claims.
  • Assisting the Fraud Department by contacting Providers.
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senior claims adjuster

  • Running daily SLA reports and assigning tasks/work distribution throughout the team.
  • Reviewing team’s suspended claims on a weekly basis and reporting back to claims team leader.
  • Coaching new team members – contact person for the team.
  • Holding presentations in monthly team meetings in cooperation with other team members.
  • Completing daily FIR audit on team and reporting back to claims team leader.
  • Participation in the AES committee on department projects and process improvements.
  • Involved in departmental projects to improve and clarify existing procedures.

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