Asst Claims Manager
Arabia Insurance Company
Total years of experience :15 years, 0 Months
• Foster and maintain relationships with high net worth clients. Also handle customer complaints.
• Provide analysis, feedback and recommendation on relevant policies to generate successful business.
• Managed main Bancassurance clients: VISA and Master Cards MENA, regional and international Banks.
• Handled claims enquiry - from coverage enquiry through legal liability assessment and quantum analysis and financial control, ensuring mitigation of indemnity and expense exposure while communicating developments and outcomes as necessary to all key stakeholders.
• Ensured that high-value complex claims are accurately assessed against policy conditions while complying with the law.
• Assist the Team Manager to complete monthly quality assurance reviews and Review service standards.
• Following up on recommendations from technical claims audits (Quality Assurance) for continuous claim handling improvement
People Excellence: Train and mentor new team members. Supervise other examiners to ensure that company guidelines are being followed and job functions are being done and goals are met. Monitor examiners notes/ activities for coaching, training and quality assistance. Track and evaluate delegated activities to surge work performance. Oversee the day to day work and requirements. Examine and analyze files to determine adequacy of claims handling. Motivate other adjusters to maintain a high level of integrity and professionalism in achieving individual and organizational goals and encouraged professional growth through effective training. Carry out peer reviews, providing feedback on a timely basis, pre-empting and addressing issues as they arise. Recruiting professional headcount s.
Conduct liability and product investigations on commercial worker’s compensation Complex, TPL auto liability and sensitive claims and coordination with experts, compensation adjusters, liability adjusters, plaintiff attorneys, and defense and subrogation counsel. Audit claims for recovery potential in consideration of comparative or contributory negligence statutes. Direct all litigation, negotiate and approve all complex disputed claim settlements. Manage and supervise litigated files with staff and outside counsel. Identify subrogation potential and assured service company pursues all valid third party claims. Identify and remove obstacles to ensure highest quality claims outcomes. Perform thorough reviews of all documentary evidence, including investigative reports. Assist in resolving issues related to claims
Develop excellent partnership with internal and external departments and ensured customer satisfaction and assisted in attracting new customers. Maintain open communication and expand network with vendors for best- Coordinate medical, vocational and outside vendor assignments. Correspond with physicians, attorneys, client companies and claimants
Maintain knowledge of all insurance lines, court decisions, and changes in policy
Track monthly/ quarterly and yearly numbers and financials
• Manage and supervise surveyors, investigators, experts, and attorneys subject to established guidelines and procedures.
• Recognise and pursue recovery where possible
• Understand in relevant products, wordings, terms and conditions and coverages
• Handled Marine Home Foreign portfolio of high valued customers, such as DHL; besides, Assisted other AIG offices (other regions) in affectively handling their Marine claims that took place in the region
• Analyse first reports to determine nature, cause, and extent of loss
• Promptly and properly develop the file to provide accurate and timely investigations and loss analysis.
Assist unit manager in the transition and testing of new claims systems (e- system); migrating from the simple system and physical documentations to e-systems and paperless environment; train the team on the how to use and to adapt the new system
Assist unit manager with claims training. Review and authorize file settlement in manager absence. Provide consultation to examiner for complex cases, settlement, acceptance or denial, or other actions as appropriate. Utilize to assist training and mentoring of claim representatives. Establish, recommend and authorize to the other claims adjusters adequate and appropriate reserves and claim payment up to policy limits
Manage a busy caseload of DBA claims, including major client accounts, Liaise with industry professionals, Legal firms, medical professionals, and vendors. Routinely prioritizing and actioning outstanding cases
Investigate, evaluate, negotiate, determine proper coverage and resolve liability for bodily injury/ death claims of moderate to severe nature within prescribed authority. Determine liability and kept a keen eye out for fraudulent claims. Negotiate settlements for complex bodily injury and death cases with all parties to timely resolution and pay appropriate benefits. Establish reserves and ensure prompt payment of associated costs. Ensure that all action on a file is quality driven to ensure adherence with company standards and in line with audit targets
Provide necessary oversight of medical vendor that are hired to provide treatment to ensure the delivery of appropriate medical care in a cost effective environment
Maintain closing ratio of 100% yearly
Handle War Hazard Recovery (Long shore claims); Responsible as subject matter expert to advise/assist compensation adjusters and management on potential and development of overseas claims for best possible recovery from the Department of Labor. Responsible to review, audit, research, prepare and send these claims to Department of Labor for reimbursement under the war hazard provisions of the Defense Base Act (5% yearly increased recovery).
Examine files to determine adequacy of claims handling. Determine coverage and pay benefits pursuant to the Defense Base Act. Manage my own day - to day work load. Correspond with physicians, attorneys, and claimants/insured
Affectively handle and accomplish instructions from management
Compute payment of appropriate benefits for temporary and permanent disability, medical treatment, vocational rehabilitation, and legal issues. Negotiate settlements. Evaluate/set reserves to cover exposure on high dollar value claims, negotiated and settled as appropriate
Coordinate claims case management with physicians and other health care professionals. Inform injured workers of all treatment options. Identify cases in need of medical management. Evaluate injured employees' compliance with prescribed physical therapy regimes. Direct medical and legal referrals
Update US department of labor of claims status and progress with action plan and negotiate settlements. Determine eligible claims under the War Hazard Recovery Act, facilitate and coordinate reimbursements of funds expended through US Department of Labor