Manage and evaluate claims inventory, conduct investigations to determine liability, negotiate settlements, and maintain accurate claim files while ensuring timely payment processing and effective communication with all stakeholders.

• Communicates with insureds, injured workers, agents, brokers, witnesses, attorneys, loss prevention, and underwriters to obtain and relate necessary information to determine coverage/compensability, facts of loss, and degree of liability/exposure. • Administers the delivery of timely, appropriate and accurate indemnity and medical benefits. • Evaluates claim exposure, negotiate and resolve claims. Works closely with defense counsel on litigated cases and attend mediation, arbitration, and hearings, as necessary. Develops litigation plan with defense counsel and tracks adherence to plan in order to control legal expenses and assure effective resolution. • Works closely with insureds and employees making visitations and presentations as needed to facilitate partnership approach to claims handling. • Maintains quality claim files in accordance with appropriate best practices, and other company procedures. • Implements Managed Care strategies, coordinate rehabilitation or medical management, process bills, review all mail through Image Right, and monitor progress as appropriate. • Interacts with State and Federal Boards and Commissions, while establishing and maintaining proper reserves, as appropriate. • Serves as a mentor and helps prepare/train the less experienced Claim Department representatives. • Keeps up-to-date on State laws and Company procedures relating to various claims; educates injured worker and/or insured on same. • Prepares and presents files for Agent/Broker Reviews and Insured File Review. • Understands medical terminology and standard medical procedures as they pertain to worker’s compensation, U.S. Longshoreman’s and Jones Act claims. • Participates in in-house and outside training programs to keep up-to-date on relevant issues/topics. • Maintains a working knowledge of all computer systems currently in use. • Travels throughout States as required to handle claims inventory assigned.

• Communicates with insureds, injured workers, agents, brokers, witnesses, attorneys, loss prevention, and underwriters to obtain and relate necessary information to determine coverage/compensability, facts of loss, and degree of liability/exposure. • Maintains contact throughout the life of the file as needed. • Administers the delivery of timely, appropriate and accurate indemnity and medical benefits. • Evaluates claim exposure, negotiate and resolve claims. • Works closely with defense counsel on litigated cases and attend mediation, arbitration, and hearings, as necessary. • Develops litigation plan with defense counsel and tracks adherence to plan in order to control legal expenses and assure effective resolution. • Works closely with insureds and employees making visitations and presentations as needed to facilitate partnership approach to claims handling. • Maintains quality claim files in accordance with appropriate best practices, and other company procedures. • Implements Managed Care strategies, coordinate rehabilitation or medical management, process bills, review all mail through Image Right, and monitor progress as appropriate. • Interacts with State and Federal Boards and Commissions, while establishing and maintaining proper reserves, as appropriate. • Serves as a mentor and helps prepare/train the less experienced Claim Department representatives. • Keeps up-to-date on State laws and Company procedures relating to various claims; educates injured worker and/or insured on same. • Prepares and presents files for Agent/Broker Reviews and Insured File Review. • Understands medical terminology and standard medical procedures as they pertain to worker’s compensation, U.S. Longshoreman’s and Jones Act claims. • Participates in in-house and outside training programs to keep up-to-date on relevant issues/topics. • Maintains a working knowledge of all computer systems currently in use. • Travels throughout States as required to handle claims inventory assigned. • Continues education in claims through Associate in Claims or Claims Law (AEI) courses.

• To analyze reported lower-level level general liability claims to determine benefits due; and to ensure ongoing adjudication of claims within company standards and industry best practices. • Handles lower-level liability and/or physical damage claims under close supervision. • Supports other claims representatives, examiners and leads with larger or more complex claims as necessary. • Processes general liability claims determining compensability and benefits due; monitors reserve accuracy, and files necessary documentation with state agency. • Communicates claim action/processing with claimant, client and appropriate medical contact. • Ensures claim files are properly documented and claims coding is correct. • May process routine payments and prescriptions and status reports for lifetime medical claims and/or defined period medical claims. • Maintains professional client relationships.