- Handle auto claims involving damage to vehicle, or liability claims involving third party vehicle or third party bodily injury from liability situations, such as motor vehicle accidents.
- Policy interpretation, investigate a loss, deciding the policy covers the loss.
- Examine claim and provide decisions accurately.
- Inspect vehicle damage to determine degree of damages.
- Examine photographs and statements.
- Consult with car manufacture, police, and field surveyor for expert evaluation.
- Verify overall coverage during the point of accident.
- Analysis of Claim data to find reason behind deviation from expected result of different claim parameters.
- Coordinating with fraud and actuary team and creating Fraud Risk Model for claim department.
- Making Board meeting ppt for National Manager based on data analysis.
- Finding Magma Ranking within 30 days settlement quarterly based on NL-24 and 25 data uploaded by companies on IRDAI website.
- Coordinating with IT department to resolve system issues.
- Ensures accurate review of claims document like LOA, hospital bills/SOA concurrent review form, physicians report, original OR for use in processing claims.
- Reviews and match the endorsed document againts the actual encoded data in the system.
- Evaluates claims and adjudicates claims to ensure claims are according to benefits plan, coverage and policies and standards.
- Accurately evaluates and process Out-patient and In-patient claim reimbursement and non-reimbursement, received from various providers and meet the required quota.
- Acting liason for General Motors customers and suppliers in investigating and claim that may result in asset loss
- Oversaw return and exchange processes from customer to supplier
- Took corrective action in the case of accidents and delays to minimize extra expenses
- Gathered, logged and monitored all shipping data
- Analyzed and reviewed claims for accuracy, completeness, eligibility and detailed research in verifying claims
- Monitored claims from start to finish making decision to determine reimbursement in a timely manner
- Process and adjust claims.
- Transfer to correct department when necessary.
- Knowledge of ICD-10 codes.
- Daily use of 10-Key.
- Knowledge of Dual monitors.
- Proficient in hotkeys.