• Reviews the claim notice, contracts, state statutes and policies to verify the appropriate coverage, deductibles, and payees • Initiates timely contact with insureds and claimants to explain the claim process and initiate the investigation • Obtains statements from insureds, claimants, and witnesses and documents summaries within the claims system • Request and analyze investigative and other relevant reports, claim forms and documents when appropriate • Documents claim activities, reserve analysis, and summaries of reports including Medicare (MSP) modules in the claim system • Sets timely, adequate reserves in compliance with the company reserving philosophy and methodology • Identifies, investigates, and proactively pursues opportunities for recovery including arranging of evidence preservation in legal compliance that meets custody, control, transfer, analysis, and disposition of physical and/or electronic evidence • Adheres to all state requirements regarding regulatory compliance by sending out letters/forms containing appropriate language according to timelines • Reviews bills, invoices and receipts for accuracy and appropriateness • Notifies people leader of claims that may need escalation or reassignment • Drafts reservation of rights and coverage denial letters with supervisor approval • Assigns vehicle/property damage appraisals and vehicle rentals • Makes recommendations to people leader on the assignment of independent adjusters • Provides prompt, detailed responses to agents, insureds, and claimants on the status of claims • Resolves questions of coverage, liability and the value of the claims and communicates with insureds and claimants to resolve claims in a timely manner • Prepares bodily injury and/or damage evaluations, negotiation ranges and target settlement numbers prior to negotiation. Obtains authority when required • Identifies and protects all liens as appropriate • Investigates Medicare liens and resolves issues in accordance with EMC and Medicare guidelines • Communicates with insureds, claimants, and attorneys to negotiate the settlement of claims • Prepares and issues settlement and release documents verifying accuracy and ensuring they are properly executed • Issues timely payments • Reviews and audits estimates written by independent adjusters for accuracy and to ensure the most cost-effective repair approach • Submits referrals to the Estimatics, Special Investigation, Subrogation, Medical Review Units and Claims Legal teams as appropriate • Prepares risk reports for Underwriting and Risk Improvement • Prepares claims and participates in claims roundtables to discuss unique cases to evaluate coverage and damage