Responsibilities
- Plans and executes thorough investigations of claims by interviewing involved parties, gathering evidence, and maintaining proper documentation control.
- Evaluates insurance coverage and verifies applicable policy terms for each claim.
- Determines liability, compensability, and extent of damages based on collected facts and policy language.
- Identifies when to involve third-party experts such as independent adjusters, medical examiners, or forensic specialists.
- Directs claims to specialized units like subrogation or fraud investigation when necessary.
- Reviews submitted claims to assess coverage validity and communicates findings to policyholders.
- Establishes initial reserve amounts and updates them throughout the claim lifecycle.
- Evaluates the actual financial impact of claims and negotiates settlements within delegated authority.
- Manages litigation timelines and coordinates legal activities for efficient resolution.
- Represents the company in court proceedings when required.
- Serves as a technical resource for the team, handling escalated and complex cases.
- Provides training and guidance to new team members to support development and consistency.
- Engages in quality assurance reviews to maintain high standards in claims handling.
- Participates in formal claim reviews including mediations, arbitrations, and internal committees.
- May support audits or reviews of closed claims files to ensure compliance and accuracy.
- Completes additional tasks as needed to support team and operational goals.
Work Arrangement
Hybrid — select offices within 50 miles of candidate's location
