- Identify, analyze and confirm coverage.
- Make first contact with parties and clients within eight business hours.
- Contact appropriate parties and providers to determine liability, compensability, negligence, and subrogation potential.
- Contact appropriate parties to obtain any needed information and explain benefits as appropriate. Continue contact throughout the life of the file as appropriate.
- Answer phones, check voice mail regularly, and return calls as needed.
- Assist with training/mentoring of Claims Adjusters.
- Assist management when required with projects or leadership as requested.
- Handle the various duties/responsibilities of the Assistant Unit Manager/Unit Manager as delegated in their absence.
- Must be willing and able to attend meetings by Skype or Facetime as requested.
- Refer all files identified with subrogation potential to the subrogation department.
- Verify loss and pertinent claims facts. Assign vendors as needed, and evaluate coverage and damages as appropriate.
- Evaluate claims, write coverage letters, and report to the clients per the claim handling guidelines.
- Recognize and report potential fraud cases.
- Develop and direct a litigation plan with a defense attorney (if assigned), utilizing all defenses and tools to bring the file to closure. Ensure all filings and state-mandated forms are completed timely. Litigated files must be diaried effectively based on current activity, but no greater than every 60 days.
- Review claim files involving active litigation every month and document responses to filings, development of defenses, depositions, and timely referral to defense counsel.
- Direct the actions of defense counsel on litigated files.
- Attend mediations and trials as required for cost-effective litigation management.
- Establish ultimate reserves (anticipated cost to bring the file to close based on known facts) as soon as practical and monitor to adjust at any exposure-changing event.
- Pay all known benefits, ensuring they are paid timely on state statute.
- Verify all provider bills have been appropriately reviewed and paid within standard timeframes.
- Report all liability issues, and potential large loss claims to the client and/or reinsurer based upon the criteria provided by the client.
- Must pass all internal and external audits, which include those performed by regulatory agencies, carriers, and clients.
- Follow reporting requests as outlined by client files and NARS guidelines.
- Document a plan of action in the claim system and set appropriate diaries.
- Maintain a regular diary for monitoring and directing medical care, case development, or litigation.
- Close all files as appropriate in a timely and complete manner.
- Maintain closing ratio as dictated by the management team.