Plans and/or conducts investigations to analyze coverage and determine liability, compensability, and extent of damages. Completes Bodily Injury Evaluation forms and/or makes recommendations for the disposition of claims in excess of individual settlement authority. Compiles information for discussion and decision-making by the claims committee where appropriate. Determines the need for independent adjusters, cause and origin experts, independent medical examiners, economists, accident re-constructionists, and engineers. Assesses actual damages associated with claims and conducts negotiations to settle claims. Determines if subrogation is appropriate and takes steps necessary to initiate recovery efforts. Evaluates policy coverage, and contacts insureds, claimants, attorneys, body shops and medical staff to determine injuries stemming from an accident while determining and establishing reserve requirements. Evaluates the medical injury exposure within guidelines, obtaining authority when appropriate, and makes proper and timely payments. Maintains accurate records and handles administrative responsibilities associated with the processing and payment of claims. Records/updates status notes and documents results of contacts, the duration of contacts and relevant medical information; reports are consistent with internal procedures and best practices. Maintains computer log indicating results of claim review and intentions for claim handling. Keeps internal and/or external customers advised of file status and other matters as required. Responds timely and appropriately to all settlement demands. Evaluates each claim for potential fraud and works with Special Investigations Unit as required. Performs other duties as assigned.
Stand Out From the Crowd
Upload your resume and get instant feedback on how well it matches this job.
Job Type
Full-time
Career Level
Mid Level
Education Level
High school or GED