Review settled insurance claims to determine that payments and settlements have been made in accordance with company practices and procedures. Report overpayments, underpayments, and other irregularities. Confer with legal counsel on claims requiring litigation.

Enter claim payments, reserves and new claims on computer system, inputting concise yet sufficient file documentation. Resolve complex, severe exposure claims, using high service oriented file handling. Maintain claim files, such as records of settled claims and an inventory of claims requiring detailed analysis. Verify and analyze data used in settling claims to ensure that claims are valid and that settlements are made according to company practices and procedures. Examine claims investigated by insurance adjusters, further investigating questionable claims to determine whether to authorize payments. Present cases and participate in their discussion at claim committee meetings. Contact and/or interview claimants, doctors, medical specialists, or employers to get additional information. Confer with legal counsel on claims requiring litigation. Report overpayments, underpayments, and other irregularities. Communicate with reinsurance brokers to obtain information necessary for processing claims. Supervise claims adjusters to ensure that adjusters have followed proper methods. Conduct detailed bill reviews to implement sound litigation management and expense control. Prepare reports to be submitted to company's data processing department. Investigate, evaluate and settle claims, applying technical knowledge and human relations skills to effect fair and prompt disposal of cases and to contribute to a reduced loss ratio. Pay and process claims within designated authority level. Adjust reserves and provide reserve recommendations to ensure reserving activities consistent with corporate policies.

English Language -- Knowledge of the structure and content of the English language including the meaning and spelling of words, rules of composition, and grammar. Customer and Personal Service -- Knowledge of principles and processes for providing customer and personal services. This includes customer needs assessment, meeting quality standards for services, and evaluation of customer satisfaction. Law and Government -- Knowledge of laws, legal codes, court procedures, precedents, government regulations, executive orders, agency rules, and the democratic political process. Clerical -- Knowledge of administrative and clerical procedures and systems such as word processing, managing files and records, stenography and transcription, designing forms, and other office procedures and terminology. Mathematics -- Knowledge of arithmetic, algebra, geometry, calculus, statistics, and their applications. Computers and Electronics -- Knowledge of circuit boards, processors, chips, electronic equipment, and computer hardware and software, including applications and programming.

Reading Comprehension -- Understanding written sentences and paragraphs in work related documents. Judgment and Decision Making -- Considering the relative costs and benefits of potential actions to choose the most appropriate one. Active Listening -- Giving full attention to what other people are saying, taking time to understand the points being made, asking questions as appropriate, and not interrupting at inappropriate times. Time Management -- Managing one's own time and the time of others. Writing -- Communicating effectively in writing as appropriate for the needs of the audience. Critical Thinking -- Using logic and reasoning to identify the strengths and weaknesses of alternative solutions, conclusions or approaches to problems. Speaking -- Talking to others to convey information effectively. Active Learning -- Understanding the implications of new information for both current and future problem-solving and decision-making. Negotiation -- Bringing others together and trying to reconcile differences. Complex Problem Solving -- Identifying complex problems and reviewing related information to develop and evaluate options and implement solutions.

Deductive Reasoning -- The ability to apply general rules to specific problems to produce answers that make sense. Oral Expression -- The ability to communicate information and ideas in speaking so others will understand. Oral Comprehension -- The ability to listen to and understand information and ideas presented through spoken words and sentences. Inductive Reasoning -- The ability to combine pieces of information to form general rules or conclusions (includes finding a relationship among seemingly unrelated events). Problem Sensitivity -- The ability to tell when something is wrong or is likely to go wrong. It does not involve solving the problem, only recognizing there is a problem. Written Comprehension -- The ability to read and understand information and ideas presented in writing. Speech Clarity -- The ability to speak clearly so others can understand you. Speech Recognition -- The ability to identify and understand the speech of another person. Information Ordering -- The ability to arrange things or actions in a certain order or pattern according to a specific rule or set of rules (e.g., patterns of numbers, letters, words, pictures, mathematical operations). Near Vision -- The ability to see details at close range (within a few feet of the observer).

Getting Information -- Observing, receiving, and otherwise obtaining information from all relevant sources. Communicating with Persons Outside Organization -- Communicating with people outside the organization, representing the organization to customers, the public, government, and other external sources. This information can be exchanged in person, in writing, or by telephone or e-mail. Interacting With Computers -- Using computers and computer systems (including hardware and software) to program, write software, set up functions, enter data, or process information. Documenting/Recording Information -- Entering, transcribing, recording, storing, or maintaining information in written or electronic/magnetic form. Communicating with Supervisors, Peers, or Subordinates -- Providing information to supervisors, co-workers, and subordinates by telephone, in written form, e-mail, or in person. Making Decisions and Solving Problems -- Analyzing information and evaluating results to choose the best solution and solve problems. Establishing and Maintaining Interpersonal Relationships -- Developing constructive and cooperative working relationships with others, and maintaining them over time. Evaluating Information to Determine Compliance with Standards -- Using relevant information and individual judgment to determine whether events or processes comply with laws, regulations, or standards. Performing Administrative Activities -- Performing day-to-day administrative tasks such as maintaining information files and processing paperwork. Interpreting the Meaning of Information for Others -- Translating or explaining what information means and how it can be used.