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Professional Summary
Claims Adjuster with deep experience in confidential litigation claims. Superbly positioned to investigate, evaluate, and settle property & auto claims. Excellent abilities to decipher fraudulent activities, analyze data, confer with legal counsel, and communicate with brokers to gain details for processing claims.
Skills
Legal proceedings knowledge
Underwriting knowledge
CCC Pathways
Hail and wind damage specialist
Subrogation expert
Policy investigations
Interior water damage background
Insurance policy coverage knowledge
Accident scene investigations
Valuation knowledge
Personal, casualty and property loss
Familiar with fraud statutes
Claims files management processes
Advanced oral and written communication skills
Data Analysis
Highly motivated
Claims Adjuster License
NextGen, Enterprise Claims System, Image Right, Audatex, Xactimate, XactAnalysis, CCC, Word, Excel, Outlook, and Windows XP, Guidewire, Katana, ClaimsSource
Work History
08/2014 to CurrentSenior Claims Desk Adjuster (Inside and Remote) Prudential | Lake Oswego, OR,
Investigated properties to determine extent of damage and estimate repair costs.
Investigated and assessed damage to property and reviewed property damage estimates.
Followed up with insured individuals regarding premium and deductibles payments.
Reconciled data in direct collection system with accounting system to address discrepancies.
Reviewed field inspections and coordinated all insurance claim audits.
Investigated claims involving potential and suspected fraudulent activities.
Examined claims forms and other records to determine insurance coverage.
Synthesized data into comprehensive quarterly written reports for management
Partnered with legal counsel on litigation cases.
Negotiated claim settlement agreements to resolve disputes.
Trained other claims staff members on proper handling and evaluation of injury claims.
Worked under minimal supervision, responsible for planning and executing the processing of assigned first party claims, that was mid to high complexity and/or severe in nature from beginning to end.
Used and managed vendors and experts in a cost-efficient manner
Handled property claims involving investigation, coverage, liability and compensability and resolved, recognizing appropriateness of settling, compromising or declining coverage
Coordinated and managed field investigations, outside engineers, contractors and cause and origin experts; and reconciled appropriateness and accuracy of costs and fees
Documented all aspects of claims, determined repair cost, replacement cost versus actual cash value, utilized replacement sources, completed proper reserving and issued payment transactions
Provided verbal and written reports and explanations on claims, process and status reports to insured’s, claimants, agents, and other interested parties
07/2010 to 08/2014Disability Claims SpecialistAscension Health | Fruit Cove, FL,
Reviewed new files to determine current status of injury claim and to develop plan of action.
Reported policy changes and company conditions affecting customer satisfaction.
Modeled exceptional customer service skills and appropriate diagnostic sales techniques to team members.
Addressed average of 150 customer inquiries and complaints each week.
Implemented improvements in manual and electronic billing procedures.
Communicated verification and authorization status updates with multi department to facilitate decision-making for patient admissions and insurance coverage.
Increased customer satisfaction by resolving serviceissues.
Delivered exceptional level of service to each customer by listening to concerns and answering questions.
06/2005 to 07/2010Claims AdjusterState Farm | City, STATE,
Examined claims forms and other records to determine insurance coverage.
Interviewed agents and claimants to correct errors or omissions and investigate questionable claims.
Drafted investigative reports covering all phases of investigation in each case.
Reviewed field inspections and coordinated all insurance claim audits.
Verified insurance claims and determined fair amount for settlement.
Answered questions posed by insured and attorneys.
Trained other claims staff members on proper handling and evaluation of injury claims.
Reconciled data in direct collection system with accounting system to address discrepancies.
Collaborated with claims department and industry anti-fraud organizations to resolve claims.
Collected information from customers to complete claims and legal files.
Investigated legal issues pertaining to claims.
Negotiated claim settlement agreements to resolve disputes.
Partnered with legal counsel on litigation cases.
Evaluated insurance policies and analyzed damages to determine coverage.
Documented all investigation activity and presented reports to management.
Education
Expected in 05/2015Bachelor of Arts | University of Memphis, Memphis, TNGPA:
Certifications
State Farm University: Auto & Property Certification
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