Investigate, evaluate, negotiate, deny, disclaim and settle all auto bodily injury claims, in accordance with State Tort Laws. Including verification of coverage, legal liability and extent of damage to persons, and property, which may require contact by telephone, email and third party vendor (attorneys, and other personnel). May require the preparation of written or computerized estimates in loss settlement, bodily injury, and pain and suffering losses. Handle a high volume of claims in a virtual or centralized environment. Ensure integrity of investigations by developing accurate and relevant investigation material and data acquisition. Ensure that all compliance requirements for claims handling states and correspondence are met in a timely and professional manner. Respond to time demands, and suits filed against both the defendant and plaintiff in a reasonable and timely manner. Issue payments as per discretionary settlement authority limits to all reasonable parties involved. Adjust reserves adequately on all new and existing claims, while Assessing comparative negligence, and reviewing all rules of the road, and all breaches of duties on all parties involved. Adjust reserves properly and understand their impact on a claim, Issue payments within authority and request more as needed. Protect lien-holders as needed, Refer files to SIU as needed, while Sending Reservation of Rights letters as needed. Looking into personal injury claims by interviewing police, physicians, or other relevant parties in order to gather supporting evidence such as photographs and medical records, determine questionable elements of the claims, and submit findings and recommendations for claims settlement within the policy limits, If the parties choose to settle in court, as the bodily injury adjuster attend trials and hearings to ensure a proper settlement and outcome for all involved.

Support management with supporting team members. Working closely with senior management. Answering questions, training new team members on policies. Conducting quality checks on members files. Assisting pre & post service coordinators with creating appeals for nurse team to work. Once appeal has been worked out by the nurse assisting with the closure process. Working to ensure all appeals are closed within compliance guidelines. As a senior, being there to assist the team with any questions that may arise. Assisting direct supervisor and management with any hot appeals/escalated and urgent. Working to make the closure process smooth and simple for all involved. Handling administrative tasks as needed. Experience producing metrics and scorecards. As a senior appeal coordinator working to bridge the gap between the coordinators and upper management. Review appeals that are received by the department, ensure that the appeals are accurate. Review to make sure that there is coverage, and that appeal has been worked properly, once verified assist to make sure appeal is closed properly. Work closely with claims, customer service, sales, and various other internal departments to ensure the appeals process is as seamless as possible. Work to ensure all appeals are done effectively, efficiently, and with great quality. If need be, review for approval, denial, or disclaimer of coverage. Review policy contracts, and policy contract language. Reach out to Provider’s office when needed to work Peer to Peers, Urgent requests as well. Also reaching out to members regarding status of appeal when needed.

*Manages, investigates and resolves vehicle damage claims for both the brand of brand of Liberty Mutual & Safeco Insurance Company across all regions. *Handle cases that require special knowledge (such as Total Loss at every severity level with a focus on moderate complexity Total Loss claims, but also able to handle Core and Express claims when necessary). Provides quality customer service to meet the needs of the insured, claimant, all internal and external customers.* Evaluates liability, and coverage, review to either afford, deny, or disclaim coverage. Handle disputes, regarding liability. Handle complex liability with multiple vehicles involved * settles claims within prescribed procedures and authority. Negotiate with both insured, claimant, lien holder, attorney and agent regarding settlement amounts. * Communicates with policyholders, witnesses, and claimants in order to gather information regarding claims, coverage, and liability, * Responds to various written and telephone inquiries including status reports.* May ensure adequacy of reserves, confirm or deny coverage and liability and advises policyholders and claimants as to proper course of action.* Negotiates settlements within prescribed authority and explains denials to policyholders and claimants.* Makes effective use of loss management techniques.* Negotiates settlements with claimants, attorneys.* Arranges for expert inspections involving third party or potential fraud actions as needed.* Updates files and provides comprehensive reports as required. Identifies and recommends referral of potentially fraudulent claims to the SIU.

•Proactively engages the member to coordinate their care needs•Keeps member actively engaged with their primary care physician and assists member with any scheduling medical appointments/transportation, clinical issues or concerns•Partners with the member’s care team (community, providers, internal staff); serving as a liaison between member and/or caregiver and all health services / processes•Conduct Social Determinants of Health assessments to identify member needs and connect member with an appropriate care team member to assist when needed.Review care history documentation (e.g., case notes); includes navigation between computerscreens and platforms to research information (e.g., medical, clinical, or benefits information•Serves as primary point of contact for internal and external stakeholders•Conducts in-bound and out-bound calls including, but not limited to member touchpoints, clinical staff coordination, member scheduling, and/or surveys/screenings•Enters timely and accurate data into the electronic medical record to communicate member needs and ensure complete documentation of member visits and phone calls•Periodically visit members/patients in facility or next site of care

Conduct recorded interviews for purposes of investigating liability, coverage, and disputes in claims.• Review and interpret policy contract language to approve, disclaim or deny coverage.• Direct liability investigations to determine percentage of negligence in auto accidents.• Maintain claim files and meet or exceed goals of quality and efficiency in regard to the claim processes.Actively listens and responds to the customer’s needs.• Ability to Issue and verify payments, transfer claims up to the correct handling adjuster when needed.• Verify accident facts, determine policy coverage, and review contracts• Interact internally with other GEICO departments and externally engage with claimants, body shops, medical providers, attorneys, outside field adjusters and other insurance companies regarding claims• Assist in settling claims where there are no injuries and all parties agrees to the accident details regarding 0 or 100% liability or escalate the claim when liability is in question or injuries are present for further investigationStrong attention to detail with time management and decision-making skills

• Detailed data entry, documentation and recording skills• Continually making outbound calls to respondents/customersto take a brief healthcare survey regarding their experience with their health care providers (i.e dialysis office, doctors office and health care insurance company)• Answering Inbound calls from customers who may have missed our call and assisting them moving forward.• Displaying client and patient sensitivity: and customer service• Familiar with the use of medical terminology, medical office and insurance company’s terms, and procedures• Update health/medical assessment of client’s current information• Consistently demonstrate flexibility and adaptability with the updated changing projects throughout the day with promptness and efficiency• Contact client office staff and customers regarding office needs, member's current issues and insurance to document information and clients’ needs• Ability to take complaint calls, and file reports and or complaints with and for the customers