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Jessica
Claire
resumesample@example.com
(555) 432-1000,
Montgomery Street, San Francisco, CA 94105
:
Professional Summary

Talented insurance professional well-versed in directing investigations, reviewing reports and assessing performance in an efficient and methodical manner. Knowledgeable about industry regulations, legal action and fraudulent claims. Demonstrated success in closing investigations, handling escalated inquiries and maintaining compliance. Excellent written and verbal communication skills with a resourceful and energetic mindset.

Skills
  • Staff training
  • Investigation oversight
  • Training skills
  • Decision-making
  • Fraud investigation
  • Claims evaluation methods
  • Business acumen
  • Project management abilities
  • Reporting skills
  • Regulatory compliance
  • Strong interpersonal skills
  • Skilled problem solver
  • People-oriented
  • Fire and Casualty, Auto and Workers Compensation claims expertise
Education
San Diego State University San Diego, CA Expected in 05/1985 Bachelor of Science : Nutritional Sciences/Business - GPA :
Certifications

WCCA - Workers Compensation Claim Associate

Chartered Property and Casualty Underwriter (CPCU)- 1995

Chartered Life Underwriter (CLU)- 2002

Chartered Financial Consultant (ChFC) - 2002

Work History
St. Joseph Health - Claim Team Manager - Special Investigations
Santa Rosa, CA, 12/2014 - 09/2019
  • Provided informational and procedural guidance to claim teams to ensure continued ability to carry out operations correctly and efficiently.
  • Managed SIU claims in accordance with industry fair claims practices and California State regulations and enforced compliance throughout department.
  • Directed team of 10 Claim Representatives focused on reviewing Special Investigation claims.
  • Trained, mentored and guided staff on investigation procedures, company policies and industry regulations.
  • Reviewed and responded to civil remedy notices.
  • Organized claims operations by preparing annual budgets, setting departmental objectives and implementing strategies to meet goals.
  • Monitored personnel performance and prescribed training and counseling to staff members to improve work outcomes.
  • Mediated and resolved sensitive customer issues and claims made by Customers to promote retention and satisfaction with services.
  • Led daily meetings on open investigations and performance optimization strategies with claim representatives and Executive management.
State Farm General Claims - Claim Litigation - Claim Team Manager
City, STATE, 09/1995 - 12/2014
  • Managed Litigated claims in accordance with industry fair claims practices and California State regulations and enforced compliance throughout department.
  • Trained, mentored and guided Attorney staff on internal procedures, company policies and Insurance industry regulations.
  • Directed team of 4 In-house Attorneys focused on managing Fire and Casualty, Workers Compensation and Automobile litigated claims against State Farm Fire and Casualty, State Farm General Company, State Farm Mutual Automobile Insurance Company and State Farm Lloyds.
  • Reviewed and responded to civil remedy notices.
  • Mediated and resolved sensitive customer issues and Litigation made by Customers to promote retention and satisfaction with services.
  • Made coverage recommendations to legal team members.
State Farm Fire And Casualty Company - Claim Team Manager
City, STATE, 04/1992 - 09/1995
  • Directed team of 13 Claim Representatives focused on managing Workers Compensation and Fire and Casualty claims.
  • Oversaw all payments, evaluations and team projects.
  • Provided informational and procedural guidance to claim teams to ensure continued ability to carry out operations correctly, efficiently and within compliance with State Insurance Regulations.
  • Mediated and resolved sensitive customer issues and claims to promote retention and satisfaction with services.
  • Made coverage recommendations to legal team members.
  • Monitored personnel performance and prescribed training and counseling to staff members to improve work outcomes.
  • Reviewed and responded to civil remedy notices.
State Farm Fire And Casualty Company - Claim Representative
City, STATE, 12/1985 - 04/1992
  • Worked effectively in fast-moving work environment to process large volumes of Fire claims.
  • Proposed settlements for uncomplicated issues to resolve claims.
  • Checked level and type of coverage and evaluated contracts.
  • Followed up with customers on unresolved issues.
  • Interviewed policyholders to verify information and obtain additional details.
  • Examined reports, accounts and evidence to determine integrity and accuracy of information.
  • Oversaw claim recoveries, including subrogation and salvage.
  • Identified suspicious losses and contacted Special Investigators for investigative assistance.
  • Delivered exceptional customer service to policyholders by communicating important information and patiently listening to all issues.
  • Read over insurance policies to ascertain levels of coverage and determine whether claims would receive approvals or denials.
  • Clarified coverage of losses to policyholders and provided assistance in itemizing damages and finding alternative living arrangements.
  • Visited customer locations to evaluate damage and provided cost estimates for remediation.
Affiliations

IASIU - Insurance Association of Special Investigation Units

Chartered Property and Casualty Underwriting - Member

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Resume Overview

School Attended

  • San Diego State University

Job Titles Held:

  • Claim Team Manager - Special Investigations
  • Claim Litigation - Claim Team Manager
  • Claim Team Manager
  • Claim Representative

Degrees

  • Bachelor of Science

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