Job Summary:

• Adjust liability claims by investigating the matter with the claimant or responsible party, researching AEP databases, and consulting with AEP's line department and other departments. 
• Obtain available documentation such as police and fire reports, documentation of the nature and cost of damages to the claimant/customer's property
• Recognize and resolve questions of coverage under the insurance policy with the assistance of a supervisor
• Determine the liability of the Company or the responsible party based on facts found in the investigation, the tariffs and Tort Law
• Determine proper expense and indemnity reserves.
• Evaluate damages for reasonableness, amounts owed or payable, and proper format (e.g., signed and dated claim worksheet). 
• Negotiate settlements based on liability and damages.
• Accurately and timely document the investigation, liability and damages in the Riskonnect claim file. 
• Complete reports and comply with internal policies and procedures
• Respond to Commission Complaints and complaints forwarded or referred to senior management.
• Assist with litigation, answer discovery requests and attend mediations
• Participate in Public Liability Accident Investigator Training sessions

Skills on Resume: 

• Claims Investigation (Hard Skills)
• Documentation Gathering (Hard Skills)
• Coverage Recognition (Soft Skills)
• Liability Determination (Hard Skills)
• Reserve Setting (Hard Skills)
• Damage Evaluation (Hard Skills)
• Settlement Negotiation (Soft Skills)
• Report Completion (Hard Skills)

Job Summary:

• Contact the employee(s) and determine the events involved in the incident/accident
• Contact third-party claimant(s) and verify the occurrence and injury
• Work with the claimant’s counsel to bring a resolution to the claim
• Work with law enforcement and legal counsel to bring a resolution to the claim
• Attend mediation and trials on cases being handled by the adjuster
• Determine the value of vehicles in the event of a total loss of the vehicle 
• Properly reserve the claim file for exposure to the company
• Work in a team environment where everyone contributes to the activities of the department
• Work with a video system to view incidents that occur at retail locations
• Investigate Subrogation exposure claims
• Work with other departments for the overall benefit of the company
• Work with the Claim system to electronically document claim activity and diary files

Skills on Resume: 

• Incident Investigation (Hard Skills)
• Claimant Verification (Hard Skills)
• Claim Resolution (Soft Skills)
• Legal Collaboration (Soft Skills)
• Trial Attendance (Hard Skills)
• Vehicle Valuation (Hard Skills)
• Claim Reserving (Hard Skills)
• Team Collaboration (Soft Skills)

Job Summary:

• Investigate, evaluate, negotiate and adjudicate claims within authority and in a manner that consistently meets or exceeds Policies and Procedures.
• Setting appropriate and accurate case reserves in accordance with the company’s reserving philosophies
• Managing attorneys and negotiating and liaising with co-insurers
• Negotiating settlements as part of the market and proactively seeking to identify and progress direct settlements solely for Enstar companies or to extend market settlements to other Enstar companies
• Keeping up to date with Lloyd’s Market Claims initiatives and attending Market Claims forums if relevant
• Reporting of claim developments and account information to management
• Contract interpretation, managing cedant relationships and legal representation.
• Conducting inspections of records and negotiating equitable claim resolution.
• Monitoring and oversight of external agreement parties against SLA’s and reporting any performance issues to Management.
• Complying with Enstar's claims handling authority levels.
• Review of and response to presentations via brokers’ files, e-marketing and on the electronic CLASS or ECF systems
• Take responsibility for the technical and pastoral development of direct reports
• Supporting and assisting Outwards, Commutation (and Complex Claims) teams, US only

Skills on Resume: 

• Claims Adjudication (Hard Skills)
• Case Reserving (Hard Skills)
• Attorney Management (Soft Skills)
• Settlement Negotiation (Soft Skills)
• Market Knowledge (Hard Skills)
• Claims Reporting (Hard Skills)
• Contract Interpretation (Hard Skills)
• Team Development (Soft Skills)

Job Summary:

• Use technical knowledge to review and adjust claims based on policy and underwriting documentation, with an assigned authority limit and claims procedures that assist in the process for setting accurate and timely claim reserves
• Maintain accurate records for auditing and regulatory purposes
• Provide operational support the claims team by producing system reports
• Support senior claims adjusters to manage and settle claims and refer cases
• Complete tasks within agreed SLAs and timescales
• Be involved in the client reporting process and MI
• Assist incoming service calls and make calls to gather information
• Liaise with a range of industry organisations
• Undertake any other tasks as requested by the Claims Manager in order that the team achieve its objectives
• Visit clients and work remotely, using claim knowledge and experience to conduct claim peer reviews.
• Provide accurate and substantive information to contribute to the production of client reporting following the conclusion of peer reviews.

Skills on Resume: 

• Claims Adjustment (Hard Skills)
• Record Maintenance (Hard Skills)
• Operational Support (Hard Skills)
• Claims Assistance (Soft Skills)
• Task Completion (Soft Skills)
• Client Reporting (Hard Skills)
• Information Gathering (Soft Skills)
• Industry Liaison (Soft Skills)

Job Summary:

• Review and analyze information including coverage, liability, medical records and other documents, in order to resolve claims
• Analyze and determine the value of the claim to set case reserves adequately
• Evaluate claims and if the loss value exceeds the granted authority limit, present the claim to the management committee for review
• Negotiate settlement, obtain appropriate releases, protect liens and authorize settlement payments
• Maintain a detailed diary of all claims and update file information to ensure an accurate record of claims activity
• Review, monitor and control the progress and expense of pending claims and comply with company standards of claims handling and closure ratios
• Analyze, interpret, and evaluate relevant information essential in settling complex high-value liability and bodily injury claims
• Identify red flags and refer suspect claims to the SIU for further review
• Ensure fast and fair claims handling compliant with applicable DOI regulations
• Work on previously worked on and/or closed claims files

Skills on Resume: 

• Claims Analysis (Hard Skills)
• Reserve Setting (Hard Skills)
• Authority Escalation (Soft Skills)
• Settlement Negotiation (Soft Skills)
• Diary Management (Hard Skills)
• Claims Monitoring (Hard Skills)
• Injury Evaluation (Hard Skills)
• Fraud Detection (Hard Skills)

Job Summary:

• Reviews the claim notice and policy to verify coverage, deductibles and compensability
• Initiates timely contact with customers to obtain information on the claim and explains the claim process
• Calculates benefits due and pays accordingly
• Coordinates return to work with a medical provider, the insured, and the injured employee
• Coordinates appropriate medical care, including using appropriate cost containment techniques and resources
• Prepares settlement evaluations, negotiation ranges and target settlement numbers prior to negotiation
• Handling of moderately complex litigated claims
• Investigate externally, participate fully in and control individual claim tactics and negotiate the settlement of low to medium complexity claims promptly, economically and equitably.
• Take a proactive approach to investigation, ADR and negotiation to avoid unnecessary litigation.
• Identify trends and pass on information on risk to the Claims Team Leader(s) / Technical Claims Manager(s) / Operations Manager and insurers to help manage the profitability of the portfolio.
• Responsible for the quality and integrity of the MI provided.
• Communicate and liaise with Clients, Brokers and Connected Services.

Skills on Resume: 

• Coverage Verification (Hard Skills)
• Customer Communication (Soft Skills)
• Benefit Calculation (Hard Skills)
• Work Coordination (Soft Skills)
• Medical Management (Hard Skills)
• Settlement Preparation (Hard Skills)
• Claims Handling (Hard Skills)
• Litigation Avoidance (Soft Skills)

Job Summary:

• Develop a plan of action to proactively close claims with a prompt and thorough investigation
• Work directly with the client-designated personnel to perform all investigative functions
• Review and interpret agreements for contractual indemnifications and/or additional insured status
• Maintain and document claim files by Client’s Claim Handling Guidelines in a clear, comprehensive, and organized manner, including a timely evaluation of liability and damages
• Establish and monitor reserves at the authority level
• Identify criteria that require notice to carriers/excess carriers and generate reports
• Handle a full caseload of pending files with appropriate diary management
• Review auto policies, claim forms and other records to verify and determine eligibility of insurance coverage under applicable state laws
• Recognize liability and transfer files appropriately
• Portraying a positive company image and engaging in professional and friendly communications with customers
• Resolving property damage auto claims in an express type/ fast track unit

Skills on Resume: 

• Claims Investigation (Hard Skills)
• Client Coordination (Soft Skills)
• Contract Interpretation (Hard Skills)
• File Documentation (Hard Skills)
• Reserve Monitoring (Hard Skills)
• Carrier Notification (Hard Skills)
• Diary Management (Hard Skills)
• Customer Communication (Soft Skills)

Job Summary:

• Handle a portfolio of Reinsurance Treaty and Facultative Property and Casualty claims arising from Excess of Loss, Proportional Treaty and Facultative business written by Berkley Re UK (BRUK). 
• Ensure claims are managed proactively and efficiently in accordance with the prevailing business, legal and regulatory environment.
• Assess policy coverage and liability for all claims notifications received within the authority
• Manage and settle claims arising on policies written by BRUK, ensuring accurate reserve calculations and managing cross-market exposures.
• Action Class/ECF and Direct claims advice, process treaty statements and deal with cash calls, expediently and within internal KPI’s, minimum standards and market expectations.
• Develop and maintain good working relationships with the Underwriting, Actuarial and Finance Teams.
• Review and maintain internal databases with relevant claims data.
• Ensure the accuracy of data contained within the claims system.
• Carry out ad hoc administration tasks
• Comply with relevant company procedures and policies.
• Act in accordance with BRUK Claims' philosophy.
• Contribute to enhancements and modifications to claims processes and systems to generate sustained improvement.

Skills on Resume: 

• Claims Handling (Hard Skills)
• Regulatory Compliance (Hard Skills)
• Coverage Assessment (Hard Skills)
• Reserve Management (Hard Skills)
• Claims Processing (Hard Skills)
• Team Collaboration (Soft Skills)
• Data Maintenance (Hard Skills)
• Process Improvement (Soft Skills)

Job Summary:

• Investigate claims as reported and determine the injured worker’s eligibility for workers’ compensation benefits
• Administers indemnity and medical benefits for valid workers’ compensation claims
• Manage the progression of the claims process through collaboration with physicians, nurses, attorneys and other parties
• Develop a thorough understanding of the underwriting and claims within the specific line of business portfolio.
• Adjust claims within the authority level and in accordance with the organisation's claims vision and obligations
• Develop and maintain close and collaborative working relationships with divisional underwriters and actuaries
• Maintain and manage claim files accurately to ensure proper claims handling within company guidelines
• Actively listening to customer needs and inquiries to determine appropriate service actions
• Handle incoming and external phone calls.
• Maintain customer records and update files on MS Office systems.
• Work well in a team and with the wider departments.
• Support customer queries and complaints efficiently.

Skills on Resume: 

• Claims Investigation (Hard Skills)
• Benefit Administration (Hard Skills)
• Claims Collaboration (Soft Skills)
• Underwriting Knowledge (Hard Skills)
• Claims Adjustment (Hard Skills)
• Stakeholder Engagement (Soft Skills)
• Customer Service (Soft Skills)
• Team Coordination (Soft Skills)

Job Summary:

• Investigate, negotiate and settle claims
• Claim investigations for exposure and within the account guidelines parameters.
• Make initial contact as per account guidelines.
• Report to the client as per account guidelines.
• Identify liability exposures, recommend reserves, recommend investigation required for exposure, prepare action plans, and negotiate settlements
• Provide a high level of customer service to clients and the insured
• Participate and share ownership and responsibility for after-hours customer service requirements (Emergency Claims Service)
• University degree or post-secondary education related to insurance
• Equivalency in combination of education and experience will be considered.
• Ongoing commitment to education and learning.

Skills on Resume: 

• Claims Settlement (Hard Skills)
• Exposure Investigation (Hard Skills)
• Initial Contact (Soft Skills)
• Client Reporting (Hard Skills)
• Liability Assessment (Hard Skills)
• Customer Service (Soft Skills)
• Emergency Response (Soft Skills)
• Continuous Learning (Soft Skills)

Job Summary:

• Handling Financial Institutions, Professional Indemnity and Directors & Officers claims in a timely and efficient manner from first notification to settlement/closure
• Assessing policy coverage as well as legal liability/quantum, effective diary and system/file management (and accurate data entry/claims notes), claims peer review
• Ensuring Nexus Claims acts an effective TPA at all times applicable claims standards and adhering to contractual delegated authorities & service level agreements
• Collaboration with Underwriters and other Claims Adjusters, Processing Technicians and Claims Operations/MI staff for the purposes of claims-related activity, payments and relevant MI, carriers and external service providers, to ensure a quality and value for money service is provided/received within required timeframes
• Determining insurance coverage including examining claim forms, policies and other records
• Interviewing claimants and witnesses, consulting police and hospital records, investigating losses, and directing or responding to telephone or written inquiries.
• Determining the insurance carrier’s liability and reaching an agreement with claimants according to policy provisions to settle claims, resolving all lines of general insurance claims of a moderate to severe exposure and complexity.
• Providing information and managing all aspects of file handling including reserving, loss control, liability assessments and investigation documentation.
• Maintaining a current electronic claim file pending, while demonstrating an effective diary system and achieving all corporate standards regarding customer service, quality and disposition.

Skills on Resume: 

• Claims Handling (Hard Skills)
• Coverage Assessment (Hard Skills)
• Standard Compliance (Hard Skills)
• Team Collaboration (Soft Skills)
• Coverage Determination (Hard Skills)
• Claims Investigation (Hard Skills)
• Liability Resolution (Hard Skills)
• File Management (Hard Skills)

Job Summary:

• Process new claims/notifications across a variety of management liability and specialty product lines, where each claim could be unique and/or may not follow a systematic or automated process.
• Produce policy documents (policy docs, endorsement schedules) and attach to claim files via Australia Processing
• Assess the details of notifications/claims by the National Head of Claims
• Ensure that every claim/notification is diarized
• Enter payments on the claims system
• Appoint appropriate legal service providers/adjusters/experts on litigated matters as requested by the National Head of Claims
• Process/approve claim payments utilizing the claims process
• Ensuring appropriate reserves are maintained on active claims
• Producing reports from the system and assisting with the preparation of the claims report by the National Head of Claims
• Attending to broker enquiries on claims and attending to follow-ups
• Managing electronic communications
• Attending to requests from underwriters
• Finalise claims on the system
• Provide insight and feedback to assist with the improvement of claim processes
• Participate in General Claims Meetings

Skills on Resume: 

• Claims Processing (Hard Skills)
• Document Production (Hard Skills)
• Claim Assessment (Hard Skills)
• Diary Management (Hard Skills)
• Payment Entry (Hard Skills)
• Provider Appointment (Hard Skills)
• Reserve Maintenance (Hard Skills)
• Broker Communication (Soft Skills)

Job Summary:

• Obtaining accurate information from customers.
• Open and closing of claims files.
• Investigating liability and indemnity.
• Working closely with customers and the supply chain.
• Assessing, coordinating and settling all claims within the settlement authority
• Responsible for servicing claims for the partner's global insurance book and managing claims for customers across the globe
• Escalating to the Claims Team Lead via the procedures established.
• Identify and communicate any issues or opportunities for improvement with the Claims Team Lead
• Implement new processes to achieve individual and team’s KPI’s
• Complete tasks within agreed SLA’s
• Claims will be managed predominantly online (collection of information)
• Assist with content translations

Skills on Resume: 

• Information Collection (Hard Skills)
• Claims Management (Hard Skills)
• Liability Investigation (Hard Skills)
• Customer Collaboration (Soft Skills)
• Claims Settlement (Hard Skills)
• Global Servicing (Soft Skills)
• Issue Escalation (Soft Skills)
• Process Improvement (Soft Skills)

Job Summary:

• Adjudicate all lines of Combined products to include Life, Accident and Health.
• Approve, deny, or inquire further for necessary information from claimants, doctors, or the hospital to assess the claimant’s eligibility for benefits.
• Interprets and administers policy provisions including eligibility and investigations.
• Review incoming correspondence concerning existing claims.
• Refer files for special investigation
• Discuss and explain benefit payments to claimants by telephone.
• Document claim file actions and telephone conversations appropriately.
• Review claims on the diary and send follow-up reminders in a timely manner.
• Refer activity outside of authority level to Senior Adjusters/Assistant Manager, Claims.
• Exercises proper judgment and decision making to analyze the claims' compensability and exposure to determine the proper course of action.
• Interacts extensively with various parties involved in the claim process.

Skills on Resume: 

• Claims Adjudication (Hard Skills)
• Eligibility Assessment (Hard Skills)
• Policy Interpretation (Hard Skills)
• Correspondence Review (Hard Skills)
• Investigation Referral (Hard Skills)
• Benefit Explanation (Soft Skills)
• File Documentation (Hard Skills)
• Decision Making (Soft Skills)

Job Summary:

• Analyze claims on multiple lines of business including Property, Construction, and Marine.
• Prepare claim correspondence to brokers and ceding companies on questions of coverage and claim value.
• Negotiate and settle claims within the specified authority.
• Set up and authorize claim payments within the specified authority.
• Work with underwriters to provide updates, evaluate exposures, and assist with the development of wordings and other contractual undertakings.
• Work with senior management of Claims, Accounting, and Underwriting.
• Perform internal and on-site claim audits on an ad-hoc basis.
• Prepare claim and statistical reports
• Assist claim handlers during CAT period and or heavy workload period
• Accurately estimating the costs of repair, replacement, or compensation associated with a covered repair.
• Negotiate labor times with service departments using nationally published labor/parts price guides.
• Negotiate prices for automotive parts and order parts according to company guidelines.

Skills on Resume: 

• Claims Analysis (Hard Skills)
• Claim Correspondence (Hard Skills)
• Claims Negotiation (Soft Skills)
• Payment Authorization (Hard Skills)
• Underwriter Collaboration (Soft Skills)
• Claims Auditing (Hard Skills)
• Report Preparation (Hard Skills)
• Cost Estimation (Hard Skills)

Job Summary:

• Handles independent insurance claims adjusting and nationwide 3rd-party claims administration.
• Set up all claim assignments that come into the company. 
• Look through the material sent in on a new claim and be able to pick out the correct information to set up the assignment. 
• Handle phone calls, but answering the phone is not a predominant part of the job.
• Handle a high volume of emails coming in, both from clients and internally.
• Review adjuster claim reports, proofing, editing, and ensuring all is in order prior to bundling the report with enclosures and sending it off to clients within the claims program.
• Handles claims in accordance with NM statutory, regulatory and ethics requirements as well as within company policies and procedures.
• Documents and communicates all claim activity timely and effective manner that supports the outcome of the claim file.
• Authorize the approval or denial of such claims based on the findings of the investigation compared to the coverage provided under the service contract.
• Examine the service contract and interview the repair facility and field inspectors to verify coverage.
• Review previous repair history and maintenance records to verify coverage under the service contract and authorize inspection to determine the extent of the company’s liability.

Skills on Resume: 

• Claims Adjusting (Hard Skills)
• Assignment Setup (Hard Skills)
• Information Extraction (Hard Skills)
• Email Management (Soft Skills)
• Report Editing (Hard Skills)
• Regulatory Compliance (Hard Skills)
• Claim Documentation (Hard Skills)
• Coverage Verification (Hard Skills)

Job Summary:

• Provide in-depth research and adjustments on adjudicated claims to ensure that all components are valid and paid/denied correctly. 
• Interface with other departments and/or health plans to resolve outstanding issues affecting claims adjudication.
• Process adjustments/refunds/reversals on assigned claims.
• Apply provider contract terms to ensure claims are accurately paid.
• Alerts manager of issues that impact production and quality, i.e. incorrect configurations, non-compliant claims, etc.
• Process claims based on compliance regulations and timeframes.
• Process both professional (CMS-1500) and facility (UB-04) claim types.
• Maintain quality and productivity standards as set by management.
• Resolve provider or physician group (network) claims inquiries and apply resolution in a timely fashion.
• Responds to questions from other Riverside departments. 
• Explains processing guidelines and internal processes
• Review services for appropriateness of charges and apply authorization guidelines during claims processing.

Skills on Resume: 

• Claims Research (Hard Skills)
• Issue Resolution (Soft Skills)
• Claims Adjustment (Hard Skills)
• Contract Application (Hard Skills)
• Production Monitoring (Soft Skills)
• Regulation Compliance (Hard Skills)
• Claims Processing (Hard Skills)
• Provider Communication (Soft Skills)