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claim specialist

  • Investigates, evaluates, negotiates, and settles auto claims in an assigned area.
  • Verifies coverage, legal liability and extent of damage to persons and property
  • Uses various electronic resources for claim handling 
  • Applies knowledge of policies, procedures, laws, statutes and insurance regulations when determining coverage, liability, and property damage
  • Interview or correspond with claimants, witnesses, police, or other relevant parties to determine claim settlement, denial, or review.Examine claims forms and other records to determine insurance coverage.

claim specialist

  • Resolved complex, severe exposure claims, using high service oriented file handling.
  • Maintained claim files such as records of settled claims and an inventory of claims requiring detailed analysis.
  • Investigated, evaluated and settled claims, applying technical knowledge and human relations skills to effect fair and prompt disposal of cases and to contribute to a reduced loss ratio.
  • Managed pivot table projects which contain provider claim discrepancies on CMS 1500 and UB-04 forms, in a timely manner resolution complete.
  • Created Policies and Procedures for Claims review

claim specialist

  • Responsible for overseeing and tracking customer inquiries at the executive level.  
  • Supported field managers with reviewing and managing independent adjuster handled claim files.  
  • Assigned to Phase I MI IPM teamCreated and wrote requirements to interface software CPS currently uses to work in IPM. 
  • Data mined Excel spreadsheets to find trends and to summarize results. 

claim specialist

  • Guide policyholder on how to proceed with a claim. 
  • Analyse a claim to establish whether it satisfies the conditions or not. 
  • Uphold relationships and communication with insurance companies and clients.
  • Negotiate and ensure fair settlement of valid claims.

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