Detail-oriented professional with extensive cross-industry experience in managing complex tasks and ensuring operational efficiency. Proven ability to maintain confidentiality while delivering exceptional results in fast-paced environments. Skilled in conducting thorough investigations, evaluating losses, and negotiating settlements that align with organizational interests. Strong relationship builder adept at understanding and addressing diverse perspectives to foster collaboration.
· Managed an inventory of claims to evaluate compensability/liability.
· Established action plan based on case facts, best practices, protocols, regulatory issues and available resources.
· Planned and conducted investigations of claims to confirm coverage and to determine liability, compensability, damages and to identify fraud indicators, ensuring claim accuracy and protecting company assets.
· Assessed policy coverage for submitted claims and notified the insured of any issues; determined the claim, referred claims to the subrogation group or Special Investigations Unit as appropriate.
· Collaborated with healthcare providers, legal teams, and claimants to gather documentation, resolve disputes, pursue early settlements and maintain fair outcomes for efficient case resolution.
· Prepared detailed investigative reports, enabling informed decision-making while upholding confidentiality and ethical standards.
· Assessed actual damages associated with claims and conducted negotiations, withing assigned authority limits, to settle claims.
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