Professional Documents
Culture Documents
of the insurance by assessing the probability of a claim being made. Your role would involve:
Assessing background information on the client Studying insurance proposals Calculating the risk Deciding how much should be paid out Liaising with professionals and specialists to help judge risk assessment Selecting appropriate and competitive premiums based on information and judgement Writing policies and adding specific conditions when required Deciding whether the risk should be shared with a re-insurer Negotiating terms
Tasks Performed
Adjust reserves and provide reserve recommendations to ensure reserving activities consistent with corporate policies. Communicate with reinsurance brokers to obtain information necessary for processing claims. Conduct detailed bill reviews to implement sound litigation management and expense control. Confer with legal counsel on claims requiring litigation. Contact and/or interview claimants, doctors, medical specialists, or employers to get additional information. Enter claim payments, reserves and new claims on computer system, inputting concise yet sufficient file documentation. Examine claims investigated by insurance adjusters, further investigating questionable claims to determine whether to authorize payments. Investigate, evaluate and settle claims, applying technical knowledge and human relations skills to effect fair and prompt disposal of cases and to contribute to a reduced loss ratio. Maintain claim files, such as records of settled claims and an inventory of claims requiring detailed analysis. Pay and process claims within designated authority level. Prepare reports to be submitted to company's data processing department. Present cases and participate in their discussion at claim committee meetings. Report overpayments, underpayments, and other irregularities. Resolve complex, severe exposure claims, using high service oriented file handling. Supervise claims adjusters to ensure that adjusters have followed proper methods. Verify and analyze data used in settling claims to ensure that claims are valid and that settlements are made according to company practices and procedures.