To direct and oversee the investigation, evaluation and resolution of Commercial General & Automobile Liability claims outsourced to a third party administrator (TPA). Evaluates the Company’s exposure and decides the appropriate course of action to best protect and prevent undue loss, mitigate associated costs and provides reserve and settlement recommendations in accordance with Company policy.
Job Duties/Essential Functions
Directs and oversees thorough and impartial investigations; determines investigation method and detail as appropriate.
Acts as a liaison between TPAs, legal counsel and vendors to manage claims, including attending trials, arbitration, ADR and face-to-face negotiations.
Provides technical direction and training to TPAs, outside counsel and department members to ensure compliance with applicable state and federal laws.
Monitors service quality provided by TPAs, outside counsel, structured settlement vendors and makes recommendations to management.
Ensures settlements are consistent with Company guidelines, policy and procedure.
Ensures claim documentation is accurate, organized and properly maintained.
Submits thorough and accurate reports as necessary.
Provides superior member service while presenting claim updates to the member.
Assists in other areas of the company as necessary.