Responsible for investigating large loss personal line property claims, determining coverage and liability, setting and adjusting reserves, evaluating claims, negotiate settlements, & authorizing and issuing payment.Manage claims for business interruption and proactively manage the periods of restoration. Independently scopes large, complex losses.Identifies and fully investigates suspicious losses. Refers claims to SIU where appropriate and may assist in investigation and settling of the claim. May deny claims based on circumstances. Communicates effectively with all levels of customers and vendors, in addition to peers and various levels of management.Applies critical thinking skills and sound judgment to various claim and business priorities, as assigned.

Evaluated auto claims involving injured parties and managed first party medical treatments to determine eligibility under a personal injury protection and/or medical payment benefit.Reviewed claims to determine the nature of the medical loss and provided explanation of coverage.Researched policy contract and interpreted policy language to make coverage decisions based on 1st party medical coverages.Assessed medical treatments, evaluated medical bills, and initiated and reviewed potential fraud investigations.Provided effective and timely communication to clients, claimants, medical providers, attorney offices, and vendors.

Provided claims service to customers regarding vehicular total losses. Documented the loss, addressed immediate questions regarding the claims process and reviews, analyzed and communicated the vehicle settlement value. Applied knowledge of auto policy coverages to initiate and/or conclude claims as appropriate. Evaluated and negotiated settlement of automobile first and third-party physical damage claims within established settlement authority limits and negotiated any excessive storage charges. Properly managed Total Loss settlement processes and rental expenses by working closely with appraisers, rental facilities, body shops, and salvage vendors. Includes managing deductibles and policy limits.Maintained salvage vendor daily contact to ensure title transfer and sale of salvage.

Analyzed and managed complex or technically difficult claims by investigating and gathering information to determine the exposure on the claim; managed claims through well-developed action plans to an appropriate and timely resolution.Assessed liability and resolved claims within evaluation.Calculated and assigned timely and appropriate reserves to claims; managed reserve adequacy throughout the life of the claim. Calculated and paid benefits due; approved and made timely claim payments and adjustments; and settled clams within designated authority level. Used appropriate cost containment techniques, including strategic vendor partnerships to reduce overall cost of claims for our clients. Reported claims to the excess carrier; responded to requests of directions in a professional and timely manner. Ensured claim files were properly documented and claims coding was correct.