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

Experienced Litigation Claims Examiner with over thirty years' experience in Commercial Liability Bodily Injury, Construction Defect, Garage/Auto Dealership claims and Negligent Security claims in the Insurance Industry. Excellent reputation for Medical/Injury claims analysis and development, superior negotiation skills, and obtaining working rapport with both defense and plaintiffs' attorneys. Expertise in litigation handling in Florida, New York, Michigan, Massachusetts, New Jersey, Missouri, Louisiana, Texas, and to a lesser extent in other states.

Well respected among industry experts, including Neuro-radiology experts, Orthopaedic experts, Neurosurgery, Biomedical and Biomechanical experts, and Negligent Security Experts.

I am known for establishing and maintaining excellent and productive relationships with assigned counsel, assisting in claims investigation, analysis, resolution and budgeting strategies. I have excelled in achieving resolutions during mediations and direct negotiations.

Skills

Complex Commercial Liability Bodily Injury, Premises Liability, Negligent Security, and Construction Defect claims.

  • Claims investigation and research
  • Complex, traumatic injury claims expertise
  • Complex, multiple unit Construction Defect
  • Negligent Security
  • Excellent negotiation skills
  • Mediation and Trial attendance
  • Medical claims submission
  • Claims reports and documentation
  • Claims evaluations
  • Claims Management
  • North Carolina and Florida Claims Adjuster License
  • Claims evaluation methods
  • Litigation review
  • Claims analysis
  • Litigation avoidance strategies
Work History
11/2012 to 04/2020 Litigation Claims Examiner Unity Health Insurance | Sauk City, WI,
  • Complex Bodily Injury Claims handling, Traumatic Brain Injury, Spinal Cord Injuries, Amputations, Complex Regional Pain Syndrome, Wrongful Death
  • Advanced negotiation skills
  • Extensive Mediation experience
  • Close working relationships with defense counsel, expert retention, analysis of medical information, claim file analysis and resolution strategy
  • Achieving almost 100% defense verdicts
  • Construction Defect litigation review of contractual agreements, scope of work for multiple trades, including general construction, plumbing, HVAC, roofing, framing, stucco, landscaping, moisture barriers, cement, etc
  • Garage and Auto Dealership litigation
  • Successfully negotiated and mediated complex liability and injury claims to resolution
  • Multiple defense verdicts
  • Coverage Analysis, including coverage litigation
  • Developed counsel assignment letter templates, bodily injury claims analysis forms and garage reservation of rights and declination letters
08/2012 to 11/2012 Claims Examiner Builder's Mutual Insurance Company | City, STATE,
  • Construction defect liability and property damage, analyzing claims, retaining experts, independent investigators, evaluating contracts, liability and resolving claims
  • Commercial auto liability property damage and bodily injury. Analyzing liability factors, injuries, vehicle damage, and resolving claims
  • Limited litigation in construction defect liability
  • Significant number of successful resolutions of construction defect claims in multiple states
09/2006 to 06/2012 Litigation Claims Examiner Nationwide Insurance | City, STATE,
  • Commercial Bodily Injury Liability Litigation specializing in complex injury claims, both in premises liability, commercial auto liability, negligent security
  • Construction Defect Liability litigation, approximately fifty percent of pending litigation assignments, including general contracting, framing, roofing, stucco, landscaping, waterproofing, window installation, electrical and plumbing contracting. Analysis of contractual documents
  • Multiple negligent security cases, including numerous wrongful death claims against apartment complexes, convenience stores, dramshop, etc. Achieved all defense verdicts in trial
  • Attendance at mediations, including mediations for other adjusters, due to experience and success in complex negotiations, ability to work with both sides to achieve resolutions
  • Attendance at trials, assisting defense counsel, including jury selection
  • Coverage litigation
  • 100% defense verdicts
11/2004 to 09/2006 Commercial Liability Claims Manager Tower Hill Insurance Group | City, STATE,
  • Commercial Liability Claims Manager, hiring, training, and supervising six claims examiners, training in investigations, negotiation, and complex medical and construction claims analysis. Assigned claims according to skill levels, worked closely with claims examiners to expand their experience levels and education levels
  • Established, organized and trained general liability claims department achieving "exceeds expectations" results in claim resolution
  • Developed claims investigation program and injury claims evaluation process
  • Excellent results achieved in educating adjusters in both loss and expense reserving and payment practices
  • Established claim contact practices resulting in accurately evaluated and resolved claims
  • Attended conferences with agents to provide training in establishing claims reporting guidelines and assistance channels
Education
Expected in 1978 Bachelor of Arts | American And World History, Foreign Languages Grand Valley State University, Allendale, MI GPA:

I majored in American, and World History, emphasis on European and Russian History. I also majored in Spanish, and minored in French,

  • Received scholarships through ACT and SAT. I also received a separate University scholarship to attend the Universidad de Granada in Granada, Spain
Accomplishments

Associate In Claims Designation

Named Three Times to the Who's Who in Insurance

Quarterly Employee Designation with Nationwide and Atlantic Casualty Insurance Company

Developed Bodily Injury analysis forms, for use by other adjusters and by defense counsel.

Utilization of Time on Risk analysis for Construction Defect

Educated defense counsel and other claims examiners on investigation of traumatic brain injury, spinal cord injury, amputations, and negligent security claims in order to properly analyze the "pure injury" value; and to apply liability factors.

Highest producing claims resolution for New York "Mediation Days" for all three years this event was held.

Certifications

Associate In Claims

Additional Information

I am active in Community Affairs in Wayne County, North Carolina, including being the Vice Chairman of the Board of Impact Teens of Goldsboro, and active volunteer with the 4-Day Movement.

I also volunteer by teaching dance at the Peggy Seegers Senior Center in Goldsboro, North Carolina

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Resume Overview

School Attended

  • Grand Valley State University

Job Titles Held:

  • Litigation Claims Examiner
  • Claims Examiner
  • Litigation Claims Examiner
  • Commercial Liability Claims Manager

Degrees

  • Bachelor of Arts

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