Susan Devlin Email & Phone Number

Albany, Ny, Us

Albany, New York, United States

As a Resolution Claim Specialist II I investigate, evaluate, negotiate, and resolve complex lost time claims within settlement and reserving authority up to stated maximum. The expectation is to reduce aging inventory as fiscally responsible as possible. I serve as a mentor and help less experienced Claim Department Representatives with settlement negotiations, valuations and settlement drafts. I evaluate claim exposure, negotiate and resolve claims. I work closely with defense counsel on litigated cases. I develop a litigation plan with defense counsel and track adherence to the plan in order to control legal expenses and assure effective resolution. I administer the delivery of timely, appropriate and accurate indemnity and medical benefits. I communicate with insureds, injured workers, agents, brokers, witnesses, attorneys, loss prevention, and underwriters to obtain and relate necessary information to determine overage/compensability, facts of loss, and degree of liability/exposure. I maintain contact throughout the life of the file. I maintain quality claim files in accordance with appropriate best practices, and other company procedures. I implement Managed Care strategies, coordinate rehabilitation or medical management, processes bills, reviews all mail through Image Right, and monitor progress as appropriate. I interact with State and Federal Boards and Commissions, while establishing and maintaining proper reserves, as appropriate. I keep up-to-date on State laws and Company procedures relating to various claims and educate injured workers and/or insureds on same. I prepare and present files for Agent/Broker Reviews and Insured File Review. I have a strong understanding of medical terminology and standard medical procedures as they pertain to worker’s compensation claims. I participate in in-house and outside training programs to keep up-to-date on relevant issues/topics. I also maintain a working knowledge of all computer systems in use.