Enhanced Claims Specialist Resume Example Frontline Insurance

ENHANCED CLAIMS SPECIALIST

Summary

Accomplished and highly-trained Licensed Claims Adjuster, Administrative, and Customer Service Professional with over 9 years of experience servicing both internal and external customers for insurance and financial service providers within a fast paced environment. Areas of expertise include, but are not limited to: Investigating and processing insurance claims, determining liability, data entry, customer service, document processing, and research.

Skills

Knowledge of office practices and strong attention to detail
Proven ability to prioritize and handle multiple tasks in a challenging environment
Excellent organizational and communication skills

Learn new software applications quickly
Proficient in: Microsoft Word, Microsoft Excel, Microsoft Access, Microsoft PowerPoint, SharePoint, AS400, Guidewire, Xactimate 28, as well as proprietary company software applications

Experience

Frontline Insurance | Lake Mary, FLEnhanced Claims Specialist07/2019 - 03/2020

Handle the adjusting of the entire claim, including collecting and reviewing all loss related facts, performing an analysis under the terms of the insurance policy to make a coverage recommendation, and issuing a payment with the applicable authority level.
Investigate, evaluate, and settle homeowner's claims.
Audit claim files and estimates for accuracy.
Compose claims correspondence.
Interact with Insured, Attorney, Public Adjuster, and Contractor throughout the claim handling process.
Maintain claims diary with an average of 100+ claims.
Utilize internal systems to record, track, and monitor claims.
Reject claims that do not adhere to policy limits, coverages, overpayments, etc.
Assist Property Adjusters with handling of complex claims and/or supplements.
Interview insured(s) and witnesses to obtain loss facts. Document all investigative actions in the claim file.
Analyze the policy to determine the coverage for the loss. Evaluate coverage and make a coverage recommendation on each claim.
Determine the total value of the claim. Request and disburse claim checks/payments within authority level. Make payment recommendation for amounts above authority level.
Check email daily. Respond to all questions in a timely manner.
Work each claim file to closure.

Team One Adjusting/Frontline Insurance | Lake Mary, FLCAT Property Desk Examiner09/2017 - 07/2019

Investigate, evaluate, and settle homeowner's claims.
Audit claim files and estimates for accuracy.
Interact with Insured, Attorney, Public Adjuster, and Contractor throughout the claim handling process.
Investigate policy coverage and review insurance contracts.
Maintain claims diary with an average of 100 claims.
Utilize internal systems to record, track, and monitor claims.
Reject claims that do not adhere to policy limits, coverages, overpayments, etc.
Assist Property Adjusters with handling of complex claims and/or supplements.
Review claims that have been processed by Property Adjusters to ensure accuracy and that company policies and procedures have been followed.
Negotiate claim estimates with Public Adjusters and Attorneys to arrive at an agreed scope of pricing.
Draft denial letters for claims regarding flood, lack of coverage, etc.
Work with engineering firms to determine cause and origin of damages to loss location.
Reviewed recommendations for causation, approval/denial made by Independent Adjusters to determine whether to approve or deny claim.
Negotiate claim settlement amount.

GEICO | Lakeland, FLLiability Claims Adjuster; PIP Examiner01/2011 - 09/2017

Handle an average of 40-60 calls daily.
Maintain claims diary with an average of 150 entries.
Utilize internal systems to record, track, and monitor claims.
Investigate and process both 1st and 3rd party claims filed.
Assist customers throughout the claims process.
Investigate policy coverage and review insurance contracts.
Take recorded statements from interested parties involved to gather pertinent information.
Examine photographs, police reports, and supporting documentation.
Investigate complex claims involving liability disputes using statements, witnesses, and police reports to assist with making liability decisions.
Handle property damage claims involving buildings and structures.
Interact with Policyholders, Claimants, Body Shops, Attorneys, Medical Providers, and other Adverse Carriers.
Investigate medical necessity and determine casualty.
Evaluate the validity of personal injury protection claims and monitor case files over the course of treatment.
Review insurance contracts, consult with involved parties, secure medical information, and review associated reports and billing documentation.
Negotiate amount of claim and settle.

Education and Training

Everest University | Lakeland, FLAssociate of Science in Business Management07/2011

Southern New Hampshire University | Manchester, NHBachelor of Science in Business Administration And ManagementExpected in 12/2022

State Insurance License

Alabama- 3000265556

Florida- W031554

Georgia- 3192571

Louisiana- 777357

Michigan- 16139050

Mississippi- 10539564

North Carolina- 16139050

South Carolina- 903889

Texas- 2286269

Resume Overview

Companies Worked For:

Frontline Insurance
Team One Adjusting/Frontline Insurance
GEICO

School Attended

Everest University
Southern New Hampshire University

Job Titles Held:

Enhanced Claims Specialist
CAT Property Desk Examiner
Liability Claims Adjuster; PIP Examiner

Degrees

Associate of Science in Business Management
Bachelor of Science in Business Administration And Management

Enhanced Claims Specialist Resume Example

Resume Score: 80%

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