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 claim or client contract
• Communicates claim action with claimant and client
• 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.
• Directed claims negotiations within allowable limits and supported successful litigations for advanced issues.
• Leveraged strong negotiation skills to resolve claim disputes, resulting in favorable settlements for both the company and policyholders.

• 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 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.
• Clarified coverage of losses to policyholders and provided assistance in itemizing damages and finding alternative living arrangements.
• Investigated and assessed damage to property and reviewed property damage estimates.
• Delivered exceptional customer service to policyholders by communicating important information and patiently listening to issues.

• Evaluate degree of liability exposure through thorough investigation tactic Make approval or denial decisions for each by reviewing evidence, estimates and photographs

• Negotiated fair settlements with claimants, ensuring both parties reached a satisfactory agreement.
• Managed high case volume while maintaining exceptional customer service and attention to detail.

• Interview and obtained recorded statements from insured claimants and witness in order to gain pertinent claim information and develop opinion on liability and value

• Prepare disclaimers, reservation of rights and other correspondence as deemed appropriate

• 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

• Investigating, evaluating, negotiating, and settling auto claims in 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
• Most importantly delivering remarkable customer experience through handling claims department for effective process
• Interview and obtained recorded statements from insured claimants and witness in order to gain pertinent claim information and develop opinion on liability and value
• Trained other claims staff members on proper handling and evaluation of injury claim
• Assist internal and external customer with problems or questions regarding claims while providing high level of customer service
• Communicate clearly and concisely policy holder's policies, limits and deductibles