Tereza Gebreab

• Manages workers compensation claims determining compensability and benefits due on long term indemnity claims, monitors reserve accuracy, and files necessary documentation with state agency.

• Develops and manages workers compensation claims' action plans to resolution, coordinates return-to-work efforts, and approves claim payments.

• Approves and processes assigned claims, determines benefits due, and manages action plan pursuant to the claim or client contract.

• Manages subrogation of claims and negotiates settlements

. • Communicates claim action with claimant and client

. • Ensures claim files are properly documented and claims coding is correct.

• May process complex lifetime medical and/or defined period medical claims which include state and physician filings and decisions on appropriate treatments recommended by utilization review.

• Maintains professional client relationships.

• Apply knowledge of insurance contracts and endorsements, state laws, and regulations for non-standard and commercial auto policies
• Initiate thorough coverage and liability investigations, identify coverage issues and exposures, draft coverage letters to first party, third party and attorneys as appropriate
• Take recorded statements from insureds, claimants, and witnesses, obtain and review evidence, and reports to determine liability
• Promptly communicates and explains terms of the policy as appropriate to team members, business partners, and/or external customers which may require contact by telephone, written or electronic correspondence as needed
• Arrange vehicle inspections for first and third party customers, review related and/or prior unrelated damage estimates, promptly process approved payments within limits
• Determined salvage value on total-loss vehicle
• Documented vehicle damage and submitted photographs and in-depth reports to claims department for effective processing
• Negotiated with claimants to settle claims
• Examined photographs and surveillance and any other documents relating to claims.

• Determined salvage value on total-loss vehicle
• Documented vehicle damage and submitted photographs and in-depth reports to claims department for effective processing
• Negotiated with claimants to settle claims
• Examined photographs and surveillance and any other documents relating to claims
• Evaluate the degree of liability exposure through thorough investigation tactic
• Make approval or denial decisions for each by reviewing evidence, estimates and photographs
• Interview and obtained recorded statements from insured claimants and witness in order to gain pertinent claim information and develop an opinion on liability and value
• Prepare disclaimers, reservation of rights and other correspondence as deemed appropriate
• Trained other claims staff members on proper handling and evaluation of injury claims
• Determine policy status and coverage, review appropriate policies for coverage, limits and deductibles
• Determine liability for loss
• Make contact with policyholders and other parties involved in loss to schedule inspection
• Maintain electronic records the accurately and thoroughly document all file handling activities
• Assist internal and external customer with problems or questions regarding claims while providing a high level of customer service
• Communicate clearly and concisely policy holder's policies, limits and deductibles
• Demonstrates a systematic approach for effective claim settlement by applying.

Investigating, evaluating, negotiating, and settling auto claims in an assigned area to include verification of coverage, legal liability and extent of damage to persons and property, which may require contact by telephone, correspondence, in person, or various electronic media

• Applying knowledge of policies, procedures, laws, statutes, and insurance regulations when determining coverage, liability, damages of injury (first and third party) and property damage

• Recognizing and reviewing claims requiring specialized handling, including identifying issues that may require the use of independent experts or vendors

• Using various electronic resources for claim handling

• Working in partnership with and provides instruction to claim associates

• Most importantly delivering a remarkable customer experience through handling claims involving injury