LiveCareer-Resume

auto claims adjuster resume example with 10+ years of experience

Jessica Claire
  • , , 609 Johnson Ave., 49204, Tulsa, OK 100 Montgomery St. 10th Floor
  • H: (555) 432-1000
  • C:
  • resumesample@example.com
  • Date of Birth:
  • India:
  • :
  • single:
  • :
Summary

Professional Claims Specialist with 10 years of experience investigating and processing P&C claims. Excel in analyzing causes, interpreting policies, and negotiating payment solutions. Able to handle assigned claims following company guidelines and industry best practices with minimal supervision.

Skills
  • Critical Thinking
  • Time Management
  • Analytical
  • Problem solving
  • Negotiation
  • Customer Service
  • Decision Making
  • Investigation
  • Claims management
  • Microsoft Office
  • Policy interpretation
  • Complex coverage issues
Experience
Auto Claims Adjuster, 08/2015 - 02/2021
Metromile Phoenix, AZ,
  • Analyzed first and third-party claims to determine the extent of the company's liability.
  • Established and maintained a high level of positive working relationships with internal and external customers, ensuring satisfaction with company services.
  • Determined insurance coverage levels and restrictions by thoroughly examining claims forms and associated records.
  • Paid and processed claims within designated authority level.
  • Improved profit margins by streamlining operations and workflow and negotiating competitive vendor contracts.
  • Negotiated settlements and agreements between parties by providing mutual support and driving resolutions.
  • Applied knowledge of P&C insurance industry products, services, and processes to include P&C insurance policy contracts & coverages, tort law, contract law, state statutes, evidence, and damages.
  • Established timely reserves and performing ongoing reviews throughout the claims-cycle by estimating and validating the value of claims.
  • Supported Underwriting teams and key stakeholders in connection with claim trends, marketing, and business development.
  • Recognized as an internal resource providing technical guidance, assistance, and training to new associates.
  • Determined the value of the claim considering depreciation and actual cash value, negotiates and commits to the settlement, and moves claim to closure.
  • Resolved complaints, and participates in arbitration and grievance procedures.
  • Created and documented claims file to comply with company guidelines and state regulations.
Subrogation Specialist, 09/2018 - 05/2020
Corvel Atlanta, GA,
  • Acquired and applies developing knowledge of P&C insurance industry products, services, and processes to include P&C insurance policy contracts & coverage, tort law, contract law, state statutes, evidence and damages.
  • Collaborated with team members to resolve issues and identify appropriate issues for escalation.
  • Delivered exceptional member experiences by communicating via the appropriate channel with the customer and through integrated solutions.
  • Reviewed questionable claims by conducting agent and claimant interviews to correct omissions and errors.
  • Analyzed information gathered by investigation and report findings and recommendations.
  • Resolved conflicts and negotiated agreements between parties in order to reach win-win solutions to disagreements and clarify misunderstandings.
  • Conducted secondary evaluations of original investigations documentation and reports to facilitate smooth resolutions.
Bodily Injury Claims Adjuster, 06/2010 - 05/2015
Concord Group Insurance Auburn, ME,
  • Settled minor to complex auto bodily injury claims after monitoring ongoing medical treatment and other ongoing procedures for appropriateness.
  • Worked directly with customers and guided them through the claims process and negotiated fair and equitable settlements.
  • Investigated, evaluated, and negotiated auto accident claims, to reach a fair and equitable settlement for all parties involved in a fast-paced environment.
  • Collected and tracked evidence in support of legal processes.
  • Paid and processed claims within designated authority level.
  • Reviewed questionable claims by conducting agent and claimant interviews to correct omissions and errors.
  • Identified insurance coverage limitations with thorough examinations of claims documentation and related records.
  • Determined liability outlined in coverage and assessed documentation such from police and healthcare providers to understand damages incurred.
  • Established coverage and eligibility based on legal interpretation of employment, relationship, course and scope, and causation.
  • Identified third-party liability and fraudulent claims.
  • Calculated loss wages, worked, and completed excel reports with findings; coordinated the activities of nurse case managers, attorneys, and subrogation specialists.
  • Ensured accurate and timely claims management and achieve positive and measurable results.
  • Monitored changes to injured worker's diagnosis to ensure ICD codes are current for Medicare purposes.
  • Reviewed police reports, medical treatment records, and physical property damage to determine the extent of liability.
Education and Training
MBA: Business Management, Expected in 06/2022
-
Strayer University - Washington, DC
GPA:
Status -
BBA: Business Administration, Expected in 05/2012
-
Berkeley College - Woodland Park, NJ,
GPA:
Status -

By clicking Customize This Resume, you agree to our Terms of Use and Privacy Policy

Your data is safe with us

Any information uploaded, such as a resume, or input by the user is owned solely by the user, not LiveCareer. For further information, please visit our Terms of Use.

Resume Overview

School Attended

  • Strayer University
  • Berkeley College

Job Titles Held:

  • Auto Claims Adjuster
  • Subrogation Specialist
  • Bodily Injury Claims Adjuster

Degrees

  • MBA
  • BBA

By clicking Customize This Resume, you agree to our Terms of Use and Privacy Policy

*As seen in:As seen in: