Manages an inventory of claims to evaluate compensability/liability. Establishes action plan based on case facts, best practices, protocols, regulatory issues and available resources. Plans and conducts investigations of claims to confirm coverage and to determine liability, compensability and damages. Assesses policy coverage for submitted claims and notifies the insured of any issues; determines and establishes reserve requirements, adjusting reserves, as necessary, during the processing of the claim, refers claims to the subrogation group or Special Investigations Unit as appropriate. Assesses actual damages associated with claims and conducts negotiations, within assigned authority limits, to settle claims. Performs other duties as assigned. Proven interpersonal, analytical and negotiation abilities required. Ability to provide information in a clear, concise manner, have attention to detail, excellent organizational skills, and ability to build effective relationships Bachelor`s degree or equivalent in addition to 1-years claiming handling experience. Knowledge of legal liability, insurance coverage and medical terminology preferred. High attention to detail: accurate data entry, thorough review of claim documentation, and careful reconciliation to minimize rework and denials. Prior HMO RE/PEI claims adjudication preferred but not required Knowledge of CPT, HCPCS, and ICD coding is preferred Licensing may be required in some states.