Jesse Latham Email and Phone Number

Promptly and effectively manage assigned claims with little to no direction which may include complex and catastrophic casualty losses. Business decisions made within delegated authority, recommend settlement values in the disposition of serious and sometimes complex claims as outlined in company policies and procedures. Adherence to high standards of professional conduct consistent with the delivery of superior service. Authorize and/or approve all claim payments within the delegated authority or within the maximum limits as outlined in company policies and procedures. Reviews billing from medical providers, medical codes via UB and HCFA forms and accurately payout claims based on policy provisions, state mandates and/or fee schedules. Verify coverage and policy information based on jurisdiction and regulatory requirements. Partner with Special Investigations Unit and Subrogation to identify fraud and subrogation opportunities. Initiate and conduct follow-up communications via phone, email, letters, etc. Familiar with billing audit system Auto Injury Solutions (AIS) and Decision Point (Mitchell). Open, close and adjust reserves within the claim. Review medical records from prior and current medical providers. Schedule Independent Exams and reviews and update claim file accordingly. Partner with Litigation Representatives and Defense Counsel regarding filed suits. Anticipate customer needs with a focus on effective communication. Negotiating and settling claims to avoid any litigation. Investigate and evaluate Michigan, complex Personal Injury Protection (PIP), medical pay and medical benefits claims for eligibility, medical necessity, appropriateness of charges for the State of Michigan (Michigan Assigned Claims Plan-MAIPF). Determine relatedness, casualty and appropriateness of treatment based on the compensable injury and make payment decisions.

Authorize and/or approve all claims payments within the delegated authority or within the maximum limits as outlined in company policies and procedures. Reviews bills from medical providers, medical codes via UB and HCFA forms. Verify coverage and policy information based on jurisdiction and regulatory requirements. Partner with Special Investigations Unit and Subrogation to identify fraud and subrogation opportunities. Initiate and conduct follow-up communicated via phone, email, letters, etc. Familiar with billing audit system Auto Injury Solutions (AIS).

Review and process salvage recovered theft process of the Fire and Theft Specialty Toys Department i.e., negotiating fees, contacting customers, scheduling pick-ups, tracking payments and net recovery amounts, closing claims, etc. Dispatch claims to adjusters in the vehicle Fire and Theft Department. Review citations sent into Nationwide. Review vehicles recovered in Mexico, deciding to bring them back to the states and working with NICB on the recovery process.

Provided the first line of customer service contact. Verified coverage and various policy information based on jurisdiction and regulatory requirements. Direct entry of secured claim information by computerized claim systems. Transferred callers to direct departments as appropriate.