- 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
- 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.
- 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.
- 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.
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.