Insurance (Claims)

 

• Management and resolution of insurance claims, such as first-party insurance claims (for individual insurance directly from an insurer, such as business interruption or commercial property insurance, that may involve bad faith allegations, such as attempting to settle for an unrealistically-low amount, blaming the loss on events other than the actual cause, denying the claim altogether, failing to perform an adequate investigation, intentional misinterpretation of the contract language against the claimant, prolonging the claims process unnecessarily, threatening to drop the claimant’s coverage if they continue the claim, unnecessarily delaying payment of claims, wrongfully claiming your loss is not covered), general claims (between an individual or multiple claimants against one or more insurers, such as for denial or undervaluing a claim), health insurance claims (between an individual and a health insurer), natural disaster claims (generally involving catastrophic property loss by an individual or business due to extreme climate or weather conditions, such as earthquakes, floods, hail, hurricanes, lightning, tornadoes, wildfires, winds) and Workers’ compensation claims (for workplace injuries sustained on the job, such as a concussion or contusion, or the loss of a limb due to operating machinery, or due to mere presence on the job over an extended period of time, such as mesothelioma form unknown exposure to asbestos); familiarity with long-term injuries and next-generation injuries (such as birth defects), caused by daily exposure to hazardous fumes emanating from a nearby plant (such as a concrete plant, chemical plant) or refinery, or contamination of the groundwater, or through various activities (such as asbestos remediation or welding).

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• Developed and implemented a claims compliance risk management strategy.

 

• Investigated claims for personal, casualty, or property loss or damages and determined the extent of the insurance company's liability and coordinates with the claims supervisor of claims needing further investigation.

 

• Reviewed insurance forms and claim documents for accuracy and completeness, and then transmits such documents to the appropriate personnel for decisions regarding denial or payment.

 

• Reviewed the claim file and the insurance policy to determine applicability coverage, if any.

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• Informed the claims supervisor of those claims needing further investigation, and why.

 

• Investigated claims through use of physical evidence, securing testimony from relevant parties, site visits and examining reports.

 

• Conducted the legal aspects of the claims system training for new and existing team members.

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    Last updated 200722_1502