Insurance

• To analyze mid- and higher-level general liability claims to determine benefits due;
• To ensure ongoing adjudication of claims within company standards and industry best practices;
• Manage mid-level general liability claims by gathering information to determine liability exposure;
• Assigns reserve values to claims, making claims payments as necessary, and settling claims up to designated authority level.
• Assess liability and resolve claims within evaluation.
• Approve and process assigned claims, determine benefits due, and manage action plan pursuant to the claim or client contract.
• Manage subrogation of claims and negotiate settlements.
• Communicate claim action with claimant and client.
• Ensure claim files are properly documented and claims coding is correct.
• May process complex lifetime medical and/or defined period medical claims which include state and physician filings and decisions on appropriate treatments recommended by utilization review.
• Maintain professional client relationships.
• Perform other duties as assigned.
• Supports the organization's quality program(s).

Claims Adjuster – Liability

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