The claim specialists report all loss notices to the applicable insurers, reviews the appropriate coverage, and monitors claims until their conclusion. A separate claim file will be opened by the specialist in Andreini’s claim management system. This allows the Director of Claims to review suspense items and to follow up quickly if action isn’t taken by the claim specialist.

Once the claim has been reported to the carrier, the claim specialist will then obtain a claim number, the adjuster’s name, email address and phone number and report the information to our client.

By checking the data in our computer system, the specialist will be able to keep our clients informed as the claim progresses. This includes the amount of deductible, limits of liability, pertinent endorsements that will affect the claim, rental car provisions, etc.

Once the claim is opened by the carrier, the claim specialist will monitor the claim to ensure that the claim is being processed timely and in accordance with state statutes and policy provisions. We also work to ensure that any payments owed to our clients are processed accurately and in a timely fashion.

If there is a problem with any claim, the claim specialist will assist the adjuster in getting those problems resolved. The specialist will work with the underwriters, the producers, and Andreini management to ensure that the carrier has accurate information in their file.

If a claim has been denied, the claim specialist will review the carrier’s denial with Andreini & Company management to develop an appropriate plan of action to form the basis of an appeal to the carrier. This may include elevating the matter to the carrier’s management executives. Andreini & Company has been highly successful in convincing carriers to accept claims they previously denied.

If a claim can be subrogated after the settlement of the claim with the insured, the claim specialist will make sure that the carrier is pursing the subrogation claim in an expeditious manner. Once recovery is made, the insurer should promptly reimburse the amount of the deductible. Regular review of subrogation files by the claim specialist and status calls to the subrogation department of the insurer is critical.

The most important function of a claim specialist is to serve as an advocate of the insured. The goal of a claim specialist is to ensure that our clients receive the appropriate policy benefits in a timely fashion. When carriers fail to do so, we will use all resources available to us to assist our clients in reaching a fair and acceptable resolution to each and every claim.