Self-motivated specializing in personal, property and casualty loss and damages. Negotiates peaceful resolutions of all claims with an emphasis on fairness and thoroughness. Trustworthy and dependable. Results-oriented Claims Adjuster bringing hands-on law enforcement experience and exceptional leadership and communication skills. Background includes criminal investigation, insurance fraud and surveillance. SUI Investigator successful at collecting and compiling information in line with the rules of evidence. Scrupulously fair and honest.
Senior Disability Claims ExaminerPrudential Financial Insurance Company of America - Portland ME11/2005 - Current
Efficiently and effectively facilitating the technical aspects of long term disability claims needing more in-depth review, many claimants in which work part-time, and appropriately applying the legal and contractual provisions.
Heavy written and verbal communication with
a diverse population of customers, including claimants with physical and
mental impairments, physicians, attorneys, benefit representatives, other
healthcare providers, and internal/external clients.
Calculate appropriate dates and payments
Develop and maintain effective working relationships
with group clients.
Lead/participate in projects/activities such
as Marketing presentations, Client meetings, Customer Action Teams, Claimant
Visits, in-service training sessions and other projects related to claim
management and staff development.
Understand and correctly utilize the appropriate
Reviewed and analyzed suspicious and potentially fraudulent insurance claims. Ran [Number] special projects and initiatives at both the local and regional level. Answered questions posed by insured and attorneys.
Disability Benefit SpecialistUNUM Group - Portland, ME10/1996 - 11/2005 This
position involves the handling of approximately 150 Long Term
Disability files. It includes risk management, timely processing of
claims, calculation of benefits, medical reviews, and strong customer
service skills. Direct contact with management, CPA's, attorneys,
medical providers and claimants on a daily basis. Senior Benefit Examiner—November 1998 to November 1999
position requires strong attention to detail while managing a caseload
of approximately 200 Partial Claims and the ability to identify claim
discrepancies and utilize risk resources for appropriate claim
resolutions. Created and enhanced partial packets and procedurals to
implement proper handling of claims. Direct contact with
management,CPA's, Disability Benefit Specialists, and medical providers
on a daily basis. Disability Benefit Processor—October 1996 to November 1998
position is responsible for the accurate handling of approximately
3,200 claims. It includes the timely calculation and issuance of benefit
payments, customer service skills, and the ability to identify risk
factors in claims that should be transferred to our Risk Unit for
management. Processing of overpayments, offsets, and mail on a daily
Foreman/Production AssistantCollege Pro Painting - Portland, ME05/1996 - 10/1996 This
position included the direction and delegation of daily assignments to
co-workers, customer sales and service, and the reduction of overhead by
20% through purchasing materials from a variety of vendors. Strong
customer relations and quality assurance on a daily basis.
Bachelor of Science: CriminologyUniversity of Southern Maine - Portland, ME1996
High School Diploma: Cony High School - Augusta, ME1989
Trainer – Senior Benefits Examiners – June 2000 to August 2000
Supervisor—Records Department—August 1999 to November 1999
position included the overseeing of operations of three record
analysts. This entailed streamlining procedures, working directly with
the records and clerical assistant's supervisors and supplying
continuous feedback through one on one conferences on a daily basis.
Disability Benefit Processor Mentor—April 1997 to November 1998
position included mentoring and training two classes of new Processors.
The ability to teach procedures while monitoring the Processors work
flow on a daily basis. This entailed being able to provide feedback in
areas of strength and those areas that needed improvement to the
Processors as well as to the management.