1. Examine claims forms and other records to determine insurance coverage.
2.Analyze information gathered by investigation and report findings and recommendations.
3.Review police reports, medical treatment records, medical bills, or physical property damage to determine the extent of liability.
4.Investigate and assess damage to property and create or review property damage estimates.
5.Interview or correspond with agents and claimants to correct errors or omissions and to investigate questionable claims.
6.Interview or correspond with claimants, witnesses, police, physicians, or other relevant parties to determine claim settlement, denial, or review.
7.Investigate, evaluate, and settle claims, applying technical knowledge and human relations skills to effect fair and prompt disposal of cases and to contribute to a reduced loss ratio.
8.Adjust reserves or provide reserve recommendations to ensure that reserve activities are consistent with corporate policies.
9.Resolve complex, severe exposure claims, using high service oriented file handling.
10.Pay and process claims within designated authority level.
11.Examine claims investigated by insurance adjusters, further investigating questionable claims to determine whether to authorize payments.
12.Verify and analyze data used in settling claims to ensure that claims are valid and that settlements are made according to company practices and procedures.
13.Enter claim payments, reserves and new claims on computer system, inputting concise yet sufficient file documentation.
14.Refer questionable claims to investigator or claims adjuster for investigation or settlement.
15.Collect evidence to support contested claims in court.
16.Confer with legal counsel on claims requiring litigation.
17.Contact or interview claimants, doctors, medical specialists, or employers to get additional information.
18.Maintain claim files, such as records of settled claims and an inventory of claims requiring detailed analysis.
19.Present cases and participate in their discussion at claim committee meetings.
20.Supervise claims adjusters to ensure that adjusters have followed proper methods.
21.Conduct detailed bill reviews to implement sound litigation management and expense control
22.Examine titles to property to determine validity and act as company agent in transactions with property owners.
23.Report overpayments, underpayments, and other irregularities.
24.Communicate with reinsurance brokers to obtain information necessary for processing claims.
25.Prepare reports to be submitted to company’s data processing department.
26.Attend mediations or trials.
27.Communicate with former associates to verify employment record or to obtain background information regarding persons or businesses applying for credit.
28.Negotiate claim settlements or recommend litigation when settlement cannot be negotiated.