Claims Specialist

• Analyzes and processes complex or technically difficult general liability claims by investigating and gathering information to determine the exposure on the claim
• manages claims through well-developed action plans to an appropriate and timely resolution
• Assesses liability and resolves claims within evaluation
• Negotiates settlement of claims within designated authority
• Calculates and assigns timely and appropriate reserves to claims; manages reserve adequacy throughout the life of the claim
• Calculates and pays benefits due; approves and makes timely claim payments and adjustments; and settles clams within designated authority level
• Prepares necessary state fillings within statutory limits
• Manages the litigation process; ensures timely and cost-effective claims resolution
• Coordinates vendor referrals for additional investigation and/or litigation management
• Uses appropriate cost containment techniques including strategic vendor partnerships to reduce overall cost of claims for our clients
• Manages claim recoveries, including but not limited to subrogation, Second Injury Fund excess recoveries and Social Security and Medicare offsets
• Reports claims to the excess carrier; responds to requests of directions in a professional and timely manner
• Communicates claim activity and processing with the claimant and the client; maintains professional client relationships
• Ensures claim files are properly documented and claims coding is correct
• Refers cases as appropriate to supervisor and management
• Performs other duties as assigned
• Supports the organization's quality program(s)
• Travels as required

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