- Manages assigned caseload with limited supervision. - Provides timely, balanced and accurate claims reviews, documentation and recommended decisions in a time sensitive and fast-paced environment. - Compiles file documentation and correspondence requiring extensive policy and factual detail. - Identifies information and resources needed to adjudicate claim. - Communicates decisions to policyholders in verbal and written form. - Conducts detailed information-gathering phone calls that obtain medical condition details, financial details, occupational details and other information. - Refers to external and internal resources, such as physicians, attorneys and CPAs to gather data such as medical/occupational information in order to ensure well-reasoned decisions. Clarifies and reconciles inconsistencies. - Proficiently calculates benefits due after elimination period, COLA, Social Security Offsets, and residual and non-routine payments.- Drafts responses to Department of Insurance and Presidential complaints. Identifies and refers appropriate matters to legal counsel.

- Worked closely with Account Risk Management in handling claims and utilizing special claim handling requirements.- Maintained positive customer relations with all accounts by making on site visits and scheduled account review conferences.- Negotiated and settled Bodily Injury exposures with damage value over $100,000, including structured settlements. - Handled suit files through entire litigation process, attended mediations and completed outside investigations.- Participated in Home Office Project to develop and improve communication between claim, underwriting and marketing divisions.- Organized training sessions, coordinated team meetings and interviewed potential claim personnel.