Enhanced Claims Specialist Resume Example
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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
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Experience
Frontline Insurance | City , STATEEnhanced 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 | City , STATECAT 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 | City , STATELiability 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 | CityAssociate of Science in Business Management07/2011
Southern New Hampshire University | CityBachelor 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
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Resume Overview
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
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