Vera Simms

Responsibilities

My responsibilities as a Manager for the RSA team include overseeing the investigation and handling of claims files. ensure coverage and liability are addressed correctly, and that the investigation is thorough. Mentor and coach adjusters to ensure that claims are handled accurately and processed in a timely manner. Provide guidance and direction on files. Collaborate with AL department to resolve the coverage issues, and the initial investigation of the claims. Oversee all legal mail and ensure a timely response to the demands and that all conditions are addressed, approve offer/ acceptance letters, denials of coverage letters, approve reserves and settlement checks above the adjuster's authority. Complete monthly QEI & FQA audits, check files for data quality, monitor monthly closing ratios, monthly Target audits. Weekly team meetings

Mentor and develop staff, resolve coverage issues, oversee incoming settlement demands/provide settlement authority to adjusters, discuss complex liability cases with the adjuster, provide direction and guidance as needed, and prepared adjusters to present files for local and Large Loss committees. Activities were set for follow-up on some of the claims files. Met monthly quality file review quotas. When reviewing claims files, esnure reserves were adequately set. For litigated files monitored timely reporting of discovery from the defense attorneys, i.e., depositions, interrogs, medical records review, use of experts – reviewed attorneys expense budget, and adjusted defense cost billings. monitored the adjuster’s trial calendar and prepared pre-trial review on liability cases, and Binding UM/UIM arbs for review with my manager depending on case value with Main Office VP's in a committee setting. Provided direction on litigated cases to the attorney (if needed).

• Below is a list of additional job titles throughout my tenure with AAA. BI Transcriptionist, Claims adjuster I, Il and III, Field Adjuster (travelled to offices within my region to cover for adjusters – paper files), BI Adjuster, Claims Rep V (oversee files handled by independent adjusters), BI Claims Examiner and BI Supervisor

• Handled first and third party litigated claims through resolution and or dismissal. When overseeing litigated cases I worked with the defense attorneys on the discovery process, monitored timely reporting of discovery (depositions of plaintiffs/ witnesses, collection of medical records). Direction provided on files to defense attorneys. Attended settlement conferences, mediations and some binding arbitrations. High/low binding arbitration's, provide counsel with company's decision to accept or reject arbitration awards.