Montgomery Street, San Francisco, CA94105609 Johnson Ave., 49204, Tulsa, OK Home: (555) 432-1000 - Cell: - resumesample@example.com - -
Summary
Energetic and enthusiastic insurance professional motivated to succeed in a fast-paced and deadline-driven professional environment. Comprehensive knowledge of claims adjustments with special knowledge in identifying elements of fraud.
Highlights
Claims file management processes
Insurance fraud expertise
Interviewing techniques
Database management
Strong interpersonal and communication skills
Self-directed
Report writing
Analytical
Team player
Critical thinker
Accomplishments
Promoted to Claims Special Investigator within 1 month of initial claims handling.
Audit scores consistently exceeded expectations and successfully maintained the highest audit scores within the Special Investigations Unit.
Experience
01/2013 to 01/2015
Special Investigative Unit IGuaranteed Returns – Portland, OR,
My primary mission has been to detect, deter and defeat insurance fraud.
Worked closely with management in various departments and assist in making coverage decisions with a focus on thoroughness, quality, cost control and mitigation of future risk.
Conducted interviews, gathered detailed information and completed field investigations.
Developed connections with local fraud bureaus, district attorneys' offices and professional associations.
Worked with house counsel in preparing cases for legal purposes.
Train claims adjusters in identifying fraud and working closely with them in addressing coverage issues and red flags.
Example of typical investigations: theft, fire, vandalism, personal injury protection (first party medical payments), third party bodily injury, rate evasion, material misrepresentation at application, out of state losses and staged losses.
Worked an intense case load in a high pace environment and had to quickly become familiar with policies in the following states: Pennsylvania, New York, Connecticut, Illinois, Texas, South Carolina and Georgia.
Share intelligence with other fraud investigators and entities, including regularly attended conferences and seminars addressing current trends and methods for combating potential fraud.
09/2010 to 01/2013
Field Adjuster II/ Claims Special InvestigatorMerck & Co., Inc. – City, STATE,
Investigate coverage and liability for personal auto policies. My performance was such that within one month of general claims handling, I was promoted to Claims Special Investigator, given the responsibility of handling the most sensitive files, often of a suspicious nature.
Reduced loss ratios through fair and prompt processing of claims.
Conducted interviews, gathered detailed information and completed field investigations.
Mentored new members of the claim staff.
Recommended settlement offers and negotiated payment arrangements.
Obtained all necessary information to complete proper evaluation of injury claims.
Drafted statement of loss to summarize damages, payments and underlying policy coverage.
Individually responsible for a high volume of work in an intense, fast paced environment working directly with management in resolving all issues related to the claim.
Manage time and work load between the office and the field.
Investigating residency, employment, automobile history, narratives given by interviewees, inspecting vehicle damage Routinely handling theft, fire, vandalism, questionable losses & other complex files.
07/2009 to 2010
Warehouse ManagerExecutive Apparel – City, STATE,
Supervised material flow, storage and global order fulfillment.
Oversaw special orders and after-hours, urgent shipping jobs.
Unloaded, picked, staged and loaded products for shipping.
Operated Visual 2000, Fedex Ship Manager and UPS WorldShip shipping systems efficiently and accurately.
Oversaw the completion of highly detailed, custom orders up to bulk product shipping.
Oversaw warehousing and storage practices and housekeeping.
Received incoming shipments and reviewed contents against purchase order for accuracy.
Telemarketing, cold calling new clients and following leads -utilized ms Excel, ms Word, and email.
06/2006 to 07/2009
Operations ManagerProvence Distinctive Catering – City, State,
Executive position. Key member of operations staff and event planning.
Managed and operated day to day activities of the warehouse and janitorial staff.
Instrumental in event planning by providing supply options that solved logistic and aesthetic issues.
Evaluated operational records and made scheduling adjustments to maximize efficiency.
Created and implemented all of the systems of organization for sending and receiving.
Oversaw special orders and after-hours, urgent shipping jobs.
Unloaded, picked, staged and loaded products for shipping.
Worked independently, had to think quickly on my feet and constantly solve evolving problems.
Independently pulled and completed work orders with on the fly adjustments.
Routinely planned out my schedule two weeks in advance.
Conducted monthly, quarterly and yearly inventories of warehouse stock.
Education
Expected in 2012
Continuing Education: Kaplan - , GPA:
Continuing education through Infinity Insurance.
Expected in 2005
Bachelor's degree: Fine Arts Pennsylvania Academy of Fine Arts - Philadelphia, PA GPA:
Fine Arts
Expected in 2001
: Hussian School of Art - Philadelphia, PA GPA:
Four year commercial art school, transferred after two years to PAFA
Expected in 1999
High School Diploma: Woodstown-Pilesgrove High School - Woodstown, NJ GPA:
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