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 UniversitySan Diego, CAExpected in 05/1985 ā āBachelor 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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