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JC
Jessica Claire
, , 100 Montgomery St. 10th Floor (555) 432-1000, resumesample@example.com
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 Current Senior 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.
  • Controlled complex property claims involving coverage, investigation, damage evaluation, settlement, denials, recovery and SIU issues.
  • 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 08/2014 Disability Claims Specialist Ascension 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 07/2010 Claims Adjuster State 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 05/2015 Bachelor of Arts | University of Memphis, Memphis, TN GPA:
Certifications

State Farm University: Auto & Property Certification

TWIA: Desk Examiner Certification

Earthquake Certification

NFIP Flood Certification Pending

FEMA Certification

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Resume Overview

School Attended

  • University of Memphis

Job Titles Held:

  • Senior Claims Desk Adjuster (Inside and Remote)
  • Disability Claims Specialist
  • Claims Adjuster

Degrees

  • Bachelor of Arts

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