- Handles claims ranging from moderate to complex with considerable latitude for action and decision.
- Makes coverage recommendations and total claim value determinations.
- Investigates coverage and cause of loss on routine to complicated claims, which includes but is not limited to policy review, evaluating current and prior medical history/problems. Interviewing all parties associated with the loss and gathering and analyzing all necessary investigative documentation.
- Reviews, evaluates and negotiates bodily injury claims with unrepresented and represented insureds/claimants including litigation management. Evaluating injury claims and property damage claims will be primary focus. Review medical records and bills to validate accuracy of services provided. Completes bodily injury evaluation summary including liability, damages, causation, diagnosis, treatment, reserves, and general damages.
- Provides accurate assessments and negotiates fair and efficient claims resolutions while managing costs. Settles losses according to the documented damage, the language of the policy of insurance, pertinent regulatory and statutory considerations and within granted authority.
- Prepares written communication, including but not limited to settlement letters, disclaimers of coverage and reservation of rights letters
- Maintains effective claim file documentation and diary system. Monitor diary to achieve timely development of file and timely disposition of the claim
- Recognizes and prepares submissions to SIU when indicated.
- Assigns and supervises vendor resources, including but not limited to independent adjusters, engineers and other experts as needed
- Helps to identify problems that affect team effectiveness or efficiency and recommend changes in procedures.
- Travels and attends mediations or training as needed.
If interested, please reach out to Carson Lippa at (646)-349-0114 or [email protected]
