Augusta Okojie

• Reviewing the quality and estimatics data of claims files to identify patterns, trends and the accuracy and completeness of documentation, including policy information, loss details, documentation of damages, and settlement calculations while maintaining the quality and integrity of the claims process incompliance with policies and procedures.

• Validates the inclusion of the necessary file documentation as part of the review process.
• Assess the appropriateness of claim reserves set, review repair estimates to ensure estimates are technically accurate and meet appropriate industry guidelines and standards for repair and Collaborate claim file as needed on Xactimate.
• Ensure that claims are processed in accordance with company policies,
by evaluating the adequacy of investigations conducted by claims adjusters to determine liability, cause of loss, and coverage applicability. Ensure that investigations are thorough and properly documented.
• Ensures that claims are processed in accordance with company policies, by evaluating the adequacy of investigations conducted by claims adjusters to determine liability, cause of loss, and coverage applicability and ensure that investigations are thorough and properly documented. Ensure the proper utilization of residential roofing code was applied.
• Verify claim calculations, and settlements are accurate and aligned with policy terms, coverage limits, deductibles, and any applicable endorsements/ exclusions and conditions were applied.
• Examine claim documentation, including photographs, estimates, and other relevant materials, to validate the authenticity and relevance of the information presented. Collaborating on Xactimate for pricelist verification and line-item confirmation as necessary.

• Engages in special projects or fulfills responsibilities in alternative areas as requested and collaborates in the enhancement and ongoing development of claim file review checklists.
• Reviewing Claim files for wind, hail, lightning, plumbing leak, hurricane, sewer backup loss and reviewing files including homeowners, dwelling, tenant, condo, personal property and liability claims files. While maintaining the company’s reputation and integrity of insurance products by complying with federal and state regulations, service standards and client requirements. Working with an active Xactimate account.

• Made approval and denial recommendations by determining accurate risk levels.
• Evaluates risks for an insurance company, advises whether the company.
• Examining insurance proposals, collecting information for risk analysis, and calculating insurance premiums.
• Collaborated with other professionals to develop innovative underwriting solutions.
• Developed and implemented underwriting policies and procedures, establishing useful and accurate processing of applications.
• Evaluated applications to determine insurance coverage and appropriate risk classifications.
• Utilized knowledge of insurance principles, policies and procedures to make decisions on risk assessment

Make initial contact with the policyholder, verifying the date of loss (DOL), reviewing the policy notice of loss for policy information, educating policyholders on their homeowner's policy when necessary and explaining to policyholders how coverage applies during the initial contact by providing detailed explanations to facilitate the prompt and accurate resolution of files adjuster [process.
• Conduct thorough investigations on property claims and review estimates, photos and all documents submitted by field adjusters making sure it aligns with the policy that is enforced.
• Review facts of loss, confirm coverage on the policies, evaluating reserve limits and settlement exposure Making claims payments as necessary, and settling claims up to designated authority level.
• Review the property in detail and revise the estimate using Symbility as needed. Prepare reports of findings using the Claim Management system. Identify, and follow up on any outstanding items needed to finalize the claim. Keep policyholders/ representatives and team leaders updated on the claim process, take recorded statements as needed, and notify the claims supervisor of claims exceeding authority level for approval. Maintain confidentiality and exercise sound judgment and discretion in handling proprietary and sensitive information related to claims.
• Drafting settlement letters to insureds/Representatives while using proper verbiage from Company workflow guideline
• Work directly with Insured and representatives to guide them through the claims process in a caring and professional manner and close all completed files as needed.

• Make initial quality first contact to policyholder Communicate, verity DOL, review the policy and review how coverage applies and provide the policyholder with a detailed explanation as necessary to facilitate the prompt, accurate resolution of claims filed.

• Conduct prompt, thorough investigations on property claim, conduct thorough investigation on estimate submitted by FA, as outlined in the claim handling, negotiation of claims as required, educated policyholders on their homeowner’s policy as needed.

• Prepare reports of findings on guidewire and review reports submitted by field adjuster for accuracy.

• Keep policyholder and team leader updated with the claim process, and taking recorded statements as needed. Notifies the Claims Supervisor of claims exceeding authority level and requiring assignment to more senior level team member.

• Review facts of loss, confirm coverage on the policies, and set reserve limits. Settles claims by determining insurance carrier’s liability, client’s instructions and authority levels required issuing settlement checks.

• Maintains the confidentiality of claim file and sensitive information, maintains company reputation and integrity of insurance products by complying with federal and state regulations, service standards and client requirements. Exercising sound judgment and discretion in any disclosure of information related to claim pay and close claim file as needed.

• Maintains professional and technical knowledge through continuing education and participate in carrier required training.