● Review contracts, plan documents, and submitted forms to create evidence-based claim resolutions per terms and conditions, guaranteeing fair and positive settlement outcomes.● Investigate and settle claims within prescribed authority levels and promptly communicate claim outcomes with claimant and client, fostering solid relationships between the claimant and the organization.● Foster solid business partnerships by providing timely and accurate policy service, addressing inquiries, and adjustment determinations within forecasted risk tolerance and investment horizon.● Assess complex claims to verify claims eligibility per policy terms and conditions, ensure reimbursement of maximum insurance claims by getting authorizations, eliminate fraud, and prevent denied claims.

● Created timely, accurate, and customer-focused Short-Term Disability, Statutory Disability Insurance, and Absence Management claim decisions to drive fair claim resolution and settlement.● Analyzed medical information to determine claims validity and accuracy of coverage concerning the proximate cause of potential liability and calculated payouts, driving equitable case settlement.● Partnered with medical professionals to adjudicate the claims process, verifying fair decision-making in claims settlement/resolution.● Interpreted and determined policies, leases, by-laws, declarations, articles, and contract coverages per legal and contractual obligations, thus driving fair claims settlement.● Built and maintained client relationships by providing timely and accurate policy service, addressing inquiries, and communicating adjustment determinations within forecasted risk tolerance and investment horizon.● Investigated, analyzed, and settled 70+ claims by verifying accident facts and determining policy coverage to validate eligibility in insurance claims, meeting standards for timely closure expectations, and working files to completion.● Reviewed and addressed complex claim coverage issues per policy terms, guaranteeing positive settlement outcomes and excellent management oversight of appropriate exposures.