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0-5 years of experience
Diligently investigated, evaluated, and negotiated multiple moderate to complex automobile, commercial, property damage and homeowner liability claims in three states (IL, IN and OH).
- Promptly recognized and coordinated investigation with Special Investigations and Legal when a claim warrants involvement.
- Contributed to reaching customer service satisfaction goals following company protocol and providing exceptional customer service.
- Mentor to new employees at a Branch level.
- Volunteered for additional training in development of skills to efficiently investigate, evaluate and negotiate commercial losses in three states.
6-10 years of experience
Investigated auto insurance claims for personal and commercial policies and effectively evaluated contract language and identified coverage issues
- Promptly and appropriately developed the file to provide an accurate and timely investigation and loss analysis.
- Adhered to all statutory and regulatory fair claims practices.
- Recognized and identified potential fraudulent claims.
- Developed and maintained strong business relationships with internal and external customers.
- Served as a technical resource to lesser experienced Adjusters.
0-5 years of experience
Consistently provided prompt contact to insureds within a 24 hour period of the initial report
- Analyzed first and third party claims to determine extent of company's liability
- Established and maintained high level of positive working relationships with internal and external customers, ensuring satisfaction with company services
- Quickly and effectively solve customer challenges
0-5 years of experience
Responsible for investigating accidents to determine liability and evaluated the cause of the accident.
- Settled minor to complex auto bodily injury claims after monitoring ongoing medical treatment and/or other ongoing procedures for appropriateness.
- Work directly with customers and guided them through the claims process and negotiated fair and equitable settlements.
- Managed multiple cases simultaneously and document every step of activity for each claim.
- Investigated, evaluated, and negotiated auto accident claims, in order to reach a fair and equitable settlement for all parties involved in a fast-pace environment.
0-5 years of experience
Successfully managed a complex and diverse caseload of property subrogation claims.
- Responsible for performing detailed day one investigations including securing recorded statements, obtaining contractual documentation, and retaining and manage forensic experts.
- Experienced in researching jurisdictional issues, case law, and managing counsel, including litigation, mediation, and arbitration.
- Effectively evaluated liability and negotiated settlements to exceed recovery targets every quarter.
6-10 years of experience
Investigate complex claim issues to identify discrepancies and determine appropriate solutions.
- Educate members/providers about plan benefits and protocols.
- Identified and reported adverse trends/patterns such as provider claims completion errors/problems.
- Conduct audits of paid, pended and rejected provider claims according to established procedures and assigned schedules.
- Researched claim inquires to resolve discrepancies, identify reasons for overpayment and inconsistent claims adjudication.
6-10 years of experience
Responsible for investigating homeowner losses, corresponding with customers over the phone while documenting all conversations, obtaining police reports, and preparing claim settlements and negotiating those damage settlements with customers
- Used service oriented approach to handle numerous types of losses and perils with a focus on theft claims, as well as following industry established best practices that provide fair settlements on claim resolutions, customer satisfaction and excellent cost management
- Conducted research to determine current market value of a loss as well as prepare structure damage estimates and work together with agents and vendors daily
- Applied specific policy coverage such as limits and denials and advising insured of specific options as available to increase their coverage and referring the customer to their agent, if needed, to increase possible limits
- Facilitated services of local police departments and vendors to assist insured with coordination of emergency benefits and services
- Recognized and Processed claims as needed for subrogation and handle notification of company interest letters sent to police
- Trained colleagues on Allstate's new nationwide software program, Xactware, as a team leader and assisted new hires with office specific best practice and Member of Team Peer Recognition Group as well as planning budget group for unit and Led my unit with most "10" ICSS Survey results
0-5 years of experience
Conducted interviews, gathered detailed information and completed investigations.
- Contact injured parties and legal representatives to negotiate final settlement for claims.
- Identified and collected evidence and determined its value to a specific claim.
- Set and adjusted claim reserves as needed.
- Reviewed files daily and update claim status.
- Prepared denials and reservation of right letters.
- Reviewed medical billing to ensure that they are casually related to the injury.
0-5 years of experience
As an Outside Claim Adjuster Representative, handled Commercial and Residential Property and Casualty structural claims.
- On each case, conducted prompt and thorough investigations through inspecting property damage, evaluating facts, interpreting laws, regulations and real estate agreements to determine the extent of the company's liability, then rendered determinations.
- Consulted with accountants, public adjusters, contractors, architects, construction workers, engineers, and lawyers in the evaluation of claims.
- Continuously analyzed case facts and monitored activities in order to identify possible fraud and/or abuse, and/or third party liability throughout the course of the claim.
- Took and reviewed photographs and written, audio-taped or video-taped statements.
- Addressed legal issues that could be handled without the use of a defense attorney. Negotiated with the claimant to settle the claim and ensured accurate and timely benefit payments.
6-10 years of experience
Investigated, evaluated, and negotiated personal automobile, homeowner, boat, motorcycle, ATV, theft and out of state accident claims.
- Established and maintained factor reserves through the review and analysis of medical reports.
- Resolved large complex casualty claims while demonstrating a thorough knowledge and practical use of medical and legal terminology, case law, statutes, regulations and company procedures.
- Worked as a field adjuster out of my home for four years. Met with insureds, claimants, and attorneys in person. Conducted scene investigations. Settled bodily injury claims in person.
10+ years of experience
- Maintained the security and built computation rules for large group claims policy in the mainframe system.
- Provided initial training and on-going system communications updates by supervising and training over 100 staff.
- Solved systems support problems for users and vendors by utilizing expert knowledge of large group claim policy.
- Managed and trained new claim adjusters with an emphasis on accuracy.
- Maintained high claims processing productivity in making decisions on payment of medical, dental, vision, life, accidental death and dismemberment claims.
- Resolved difficult questions and problems for insured, brokers, and others that the telephone representatives were unable to handle. Built strong reputation with outside vendors by helping them address their employees.
- Ensured accuracy by checking the work of claim adjusters.
0-5 years of experience
Determined coverage on all cases assigned.
- Investigated, evaluated and made liability decisions on assigned claims.
- Communicated information effectively, both written and oral.
- Reviewed all files assigned thru the use of a regular diary system.
- Established preliminary reserves and regularly reviewed them for adequacy.
6-10 years of experience
Reviewed and analyzed medical data relative to negligence and liability issues to determine injury value.
- Performed monthly review of employee quality and compliance.
- Supervised, directed and allocated work assignments for a team of 5 claims adjusters. Also performed quarterly and annual performance appraisals.
- Implemented customer service guidelines to improve customer satisfaction success.
10+ years of experience
- Investigated, evaluated, negotiated and settled property, casualty and workers compensation claims. Draft authority and issued checks.
- Effectively maintained a heavy pending caseload.
- Worked closely with underwriting department to evaluate risks.
- Supported clerical staff when needed with busy phone lines and general office duties.
- Self Starter Employee and full of energy.
0-5 years of experience
Investigated and administered benefits for severe, high-value workers' compensation claims across. Wrote and presented detailed reports analyzing large claim exposures and formulated appropriate resolution strategies to Risk Managers and insurance carrier representatives.
- Served as dedicated technology trainer for new employees learning to use company software and hardware
- Supervise 1 - 2 junior claims adjusters
- Authored and conducted client/employer claim handling and claim investigation seminars
- Lead employees through property/casualty license examination training
6-10 years of experience
- Applied strong customer service, organizational and multitasking skills to efficiently manage auto insurance claims
- Handled over 500 calls a month while maintaining highest standards of call quality and service
- Coordinated with insured's, claimants, repair facilities, rental car companies for timely completion of auto repair to conclude claim
- Negotiated liability with other carriers and referred files to subrogation for collection
0-5 years of experience
- Processed first and third party Bodily Injury Claims
- Communicated effectively with internal and external customers
- Reviewed claims for potential subrogation opportunities
- Identified claims with potential fraudulent indications and refer to SIU referrals
- Resolve coverage issues, assigned necessary reserves, and secured releases
- Maintained a 1:1 closure ratio and daily diary review
0-5 years of experience
Handled Personal lines Auto BI (80%) Commercial Auto BI (10%) and General Liability (10%) Claims.
- Handled Litigation Claims to include the direction of Defense Counsel.
- Reported to re-insurers and clients on cases involving serious injuries and fatalities. Attended mediations and trials as required.
- Member of In-House Education Committee assisted in training of adjusters.
0-5 years of experience
Investigated losses through interviews, recorded statements, data/documentation, gathering and securing and preserving evidence.
- Evaluated liability and damages.
- Developed strategy and negotiated claims to timely conclusion.
- Determined need for and directed counsel or other technical experts.
0-5 years of experience
- Investigated losses, evaluated liability and damages, negotiated and settled property claims.
- Positive record of accomplishment on mediation, arbitration, litigation, settlement, assessment and valuation.
- Served as resource and subject matter expert to policyholders, agents, underwriters, and property vendors.
0-5 years of experience
- Interviewed all parties involved in the initial reporting of a workers' compensation claim.
- Investigated claim reports to determine compensability
- Ensured data accuracy and timely processing while adhering to legislature regulations/laws and company rules/policies.
- Researched and maintained files through legal proceedings to ensure timely processing of all bills associated with a claim.
- Research and assign medical codes according to incidents to ensure Medicare compliance.
0-5 years of experience
Confirmed and investigated coverage for auto accident, vehicle theft, and vehicle fire claims.
- Investigated and determined liability for multiple vehicle accidents.
- Managed the vehicle repair process by payment of appraisals, supplements, and monitoring the rental exposure.
- Referred files appropriately based on suspicious facts of loss, damages, or where subrogation potential was evident.
10+ years of experience
Was responsible for investigating, negotiating and settling large sized Homeowners claims.
- Created documentation process which clearly layout claims involving damaged structural and personal property using pertinent information gathered.
- Complied closely with Department of Insurance Regulation reaching one of the lowest violation rates in the company.
- Consistent leader in customer service score using patience and sympathy to provide professional responses when speaking to a wide variety of people in various stages of expectation.
- Proactively reached out to insured to keep them informed with claim process and addressed any concerns with consideration to reduce their stress level.
- Coordinated with vendors and reviewed structure repair estimates.
- Determined when to investigate potential fraudulent claims and prepare for subrogation.
- Managed catastrophic losses and after hour emergency situation.
- Handled California and out of State claims including Texas, New Hampshire, New Mexico, Maine, Pennsylvania, and Hawaii.
6-10 years of experience
- Successfully managed large caseload of disability claims for the State of Michigan Long Term Disability Income Replacement Plan.
- Provided contractual, medical and financial analysis in a timely and accurate manner.
- Calculated benefit payments and overpayments.
- Communicated effectively with policyholders, legislators, claimants, vendors and the medical community.
0-5 years of experience
Developed a strong understanding of insurance policies and claims procedures through multi-week training.
- Conducts coverage and liability investigations for automobile claims in compliance with state law and company policy.
- Utilizes many different avenues to obtain necessary documentation and investigation information.
- Coordinates with field staff, body shops, specialized departments, and claimant carrier representatives to achieve efficient and positive claim outcomes.
- Consistently exceeds metric goals while maintaining a workload of 60-100 claims.
- Primarily handles New York and Michigan claims. Secondary states include Pennsylvania, Ohio, Indiana, and Oregon.
10+ years of experience
Conducted interviews/recorded statements of insured, claimants, fire and police personnel, cause and origin experts, and witnesses; Investigated property damage and bodily injury claims to determine extent, cause of loss, and liability/exposure
- Negotiated settlement with 1st party property owners/insured and 3rd party claimants within authority
- Confirmed coverage and full understanding of insurance contract/policy and their exclusions
- Prepared written reports of findings for claims manager, attorneys, general manager
- Attend litigation hearings, settlement conferences, case evaluation
- Prepared correspondence for Appeal Committee and Large Loss Committee
0-5 years of experience
- As an entry level claim adjuster, trained and handled both first and third party property, liability and auto claims.
- Assigned and managed independent adjusters and appraisers.
- Drafted and resolved binding arbitration cases.
- Worked with SIU in resolving fraudulent claims.
6-10 years of experience
Initiates claims review or appeals as indicated on assigned explanations of benefits with various medical insurance.
- Worked the Epic systems and completed 25-35 claims per hour and did exceed my goals and expectations while saving the company a lot of man hours.
- Worked and covered other departments while employees were out sick.
- Follow up on all pending claims.
10+ years of experience
Examine and process automotive warranty claims filed by the customer from the initial filing to completion. Process includes matching the customer to the correct vehicle, logging required parts, providing labor estimates from the repair facilities, also setting up the claim for payment to the repair facilities.
- Assesment of expenses and confirmation of policy compliance.
- Promoted from customer service to claims adjuster
- Consistently exceeds daily phone requirements, statistics and yearly reviews.
- Assists customers effectively by solving customer disputes
- Made payments to repair facilities after the approval of the claim.
- Assisted in the loss and prevention department for review of specific claims and repair facilities.
0-5 years of experience
Provided prompt, accurate and courteous replies to written and telephone inquiries relating to medical benefits and coding
- Assisted members with Spending Accounts(FSA, HAS)
- Reviewed medical policies with providers to ensure proper coding
- Adjusted bodily injury claims
- Assisted with reviewing records to determine primacy of coverage
0-5 years of experience
Conducted telephone recorded interviews with first party, third party and witnesses.
- Responsible for negotiation attempts to settle bodily injury claim with the claimant prior to transferring file to Casualty or Litigation Department.
- Processed and resolved first party personal injury protection and medical payment claims.
- Negotiated liability negligence percentages with third party claimants and adverse carriers.
- Processed and resolved first party personal injury protection and medical payment claims.
0-5 years of experience
Analyzed and processed hospital, long term care, major medical, and surgical claim inquires for benefit decisions
- Communicated claim decisions to guarantors and policyholders formal benefit letter i.e. Explanation of Benefits notice
- Requested claim material from health care providers to render payout decisions
- Responsible for providing administrative service for departmental supervisor
- Verified and approved high dollar claims for payment release
0-5 years of experience
- Audited medical bills for correct CPT and ICD-9 coding, initiated independent medical exams/peer reviews, and evaluated the results to ensure appropriate payment and assist in fraud prevention
- Investigated and processed claims through administration of recorded statements
- Negotiated with claimants, attorneys and other insurance carriers to regarding settlement
0-5 years of experience
- Handled arbitrations
- Investigated insured's accident
- Reviewed policies
- Paid medical providers accordingly
- Handled over 1,000 claims start to closure
- Promoted three times in recognition of outstanding performance - hired as a secretary, promoted to assistant then adjuster
6-10 years of experience
- Investigated claims against insurance for personal, casualty, property loss and damages
- Examined claim form and other records to determine insurance coverage
- Interviewed, telephoned, and corresponded with claimant and witnesses
- Consulted police and hospital records
- Trained co-workers in the job
- Inspected property damage to determine extent of company's liability, varying method of investigation according to type of insurance
- Prepared report of findings and negotiated settlement with claimant
- Successfully handled auto claims
10+ years of experience
Investigates claims against insurance or other companies for personal, casualty, or damages and attempts to effect out-of-court settlement with claimant: Examines claim form and other records to determine insurance coverage.
- Interviews, telephones, or corresponds with claimant and witnesses; consults police and hospital records to determine extent of company's liability, varying method of investigation according to type of insurance.
- Prepares report of findings and negotiates settlement with claimant.
- Recommends litigation by legal department when settlement cannot be negotiated.
- Adjusted claims for Banker's employees, the city of Chicago, fire department and Inland Steel
- Billed clients, doctor offices and hospitals.
- Greeted client and/or their families when they entered the lobby often to pick up checks for death benefits
0-5 years of experience
- Investigated and analyzed polices, endorsements, coverage, facts, liability and damages on all assigned losses to ensure accuracy and timely
- Managed the work of vendor partners to ensure their work met the company's quality expectations
- Maintained all mail in a paperless environment, as well as, an active diary and phone calls within the company's standard
- Obtained and documented information on the circumstances of the loss
- Set initial reserve and evaluated as facts change; made or recommended
- Researched, analyzed and interpreted policy language and state laws as needed
6-10 years of experience
Dallas, TX 2000 - 2010
Auto Theft and Fire
Handled claims files that involve automobile theft and fires for the United States. Review the insured policy to confirm coverage. Explain the coverage that applies to the claim in question to the insured. Made contact with all parties involved. Investigate the facts of the loss. Assign a field adjuster to inspect the damage vehicle. Recognize if there is potential fraud during the investigation. Concluded claim by payment where warranted.
- Lead the unit by submitting files to subrogation and collecting > $275 in 2009, in 2008 collected >$354K in 2007 collected >$256K for the department.
- Met performance standard of 98% Compliance with Good Faith Claim Handling Practices and State DOI Regulations, 98% compliance with TL Best Practices, Rental Guidelines, Policy Provisions, and Secured Proper information such as Lien Holder information, Titles and Power of Attorney.
- Maintained 100% accuracy for paying state regulated fees in accordance to total loss claim handling. 98% on the overall accuracy for the settlement offer.
- Effectively managed individual pending with a closing ratio of 95-102% for COLL, COMP & PROP suffixes.
- Reviewed NICB/ISO reports to check vehicle recovery status and rule out similar reported loss.
- Confirmed vehicle information with theft affidavit.
- Referred a total of 367 files to SIU department in 2007, 2008 and 2009.
6-10 years of experience
Balanced ~50 calls per day while medically managing a 200+ organized file inventory
- Demonstrated leadership skills by assisting peers on time management, follow up issues, claim handling and customer service
- Translated policy language to customers who were unfamiliar with coverage and benefits
- Investigated medical treatment/bills to ensure proper services were provided and billed accordingly
- Expedited medical payment of bills as per NJ State regulations
- Correspond and established rapport with customers on issues related to medical processing steps, precertification, coverage and deductibles.
- Recognized for providing exceptional customer service by actively listening to customers and helping them recover from the unexpected
6-10 years of experience
Investigate first party claims to determine the extent of damages, make approval/denial decisions and negotiate settlements with insured's in accordance with state and policy provisions. Collaborate with insurance agents, underwriters and special investigators to correct errors, rectify omissions and investigate questionable issues.
Outcomes:
- Resolved more than five thousand claims throughout my tenure. Provided optimal service to policyholders, negotiated fair settlements and identified fraudulent claims.
- Achieved numerous high percentage contact and closures results relating to 24 hour contact and 30 day closure.
- Selected by supervisors to resolve complex claim issues; participate in quality control audits; and assist other team members with claim loads.
- Maintained superior quality ratings in file handling and resolution office goals on a regular basis.
- Developed a strong understanding of insurance policies and legal issues through hands on claim handling, coupled with in-depth, multi-week claim training.
- Received In-Synch Nominee Performance Award (2005) and several service awards (2001, 2003, 2004)
6-10 years of experience
Manage, Investigate, evaluate, reserve, negotiate and settle assigned bodily injury claims in accordance with best practices.
- Provide quality claim handling and superior customer service on assigned claims.
- Reduced indemnity & expense ratios by 18%.
- Promptly managed claims by completing essential functions including contacts, investigation, damages development, evaluation, reserving, litigation management and disposition.
- Managed a team of subrogation representatives.
- Managed team metrics driving revenue collections which exceeded goal by 78%
0-5 years of experience
[company name]/ Hanover Insurance Windsor, CT
Claim Adjuster- Commercial Lines 8/2012- current
- Investigated and resolved first and third party automobile claims for Commercial lines book of business.
- Handled No Fault (PIP) claims for New York , New Jersey and Pennsylvania
- Evaluated and settled bodily injury claims.
- Interacted with insured, agents, claimants, attorneys, appraisers and auto body shops to settle claims appropriately.
- Determined subrogation opportunities and pursued recoveries
0-5 years of experience
- Field Adjuster. Defined and controlled scope of damage, determined cost of repair and approved settlement.
- Residential concentration with some commercial accounts.
- Successfully served on approximately a dozen CAT tours, including Hurricane Katrina. Tours for damages ranging from hurricane, hail and flood.
- Collaborate with Underwriting to sell the product.
- Great success was achieved by amicably resolving claims with high-end customers as illustrated by a 92% survey rating.
0-5 years of experience
Personal Injury Protection / Medical Bill Payments (PIP/Med Pay)
Thoroughly reviewed all medical records, damage information and loss facts to determine injury causation and identify related and non-related injuries or conditions. Identified any pre-existing and/or subsequent medical injuries of conditions and assess their impact on the overall injury claim. Reviewed any applicable medical resources to assist in decision making and support for the evaluation of the insured medical records (IME-Internal Medical Exam). Complete a Decision Point medical bill review audit of the medical bills and treatment.
- Identified any pre-existing and/or subsequent medical injuries or condition.
- Confirmed patient's prognosis and treatment plan and compare to actual treatment.
- Identified inconsistencies or indications of potential abuse regarding the treatment of patient.
- Thoroughly documented the results of the treatment, damage investigation and evaluation.
- Ensured the customer/Claimant is kept adequately informed, receives a clear explanation 96%.
- Insured claimant contact 100%.
- Complied with Good Faith Claim Handling Best Practices and DOI regulation 100%.
6-10 years of experience
Tenacious focus on customer needs/concerns to provide excellent customer service in English and Spanish
- Knowledge and translation of policy language
- Creation of and participation in mentorship program
- Participation in multiple internal engagement office committees
- Investigated and analyzed evidence to determine liability
- Negotiated injury settlements and claim processes with customers, claimants and attorneys for the mutual benefit of all involved parties
- Legal Principles Claim Specialist designation by American Educational Institute, Inc
- Organized and maintained manageable file inventory
0-5 years of experience
All Lines Adjuster Lic. #1753888)
New York
- Worked as a clerical assistant during Hurricane Sandy in the field Oct.-Dec 2012
- Made initial and follow up phone calls, scheduled appointments, answered customer questions
- Accompanied the adjuster to appointments and participated in assessing damages, scoping properties
- Created reports and recommendations to supply insurance companies with accurate damage assessment
6-10 years of experience
- 4 years experience as medical claims adjuster.
- Processed medical claims, referrals and customer escalations.
- Maintained first level contact via telephone with customers throughout claim process.
- Responsible for claims verification process necessary for determining customer benefits along with claim mitigation procedures and customer support during mitigation process.
- Conducted prompt and thorough investigations, evaluated facts, interpreted laws and regulations, and rendered determinations, including compensability and medical determinations.
- Consulted with accountants, architects, construction workers, engineers, and lawyers in the evaluation of a claim. Continuously analyzed case facts and monitored activities in order to identify possible fraud and/or abuse, and/or third party liability throughout the course of the claim.
- Considered the relative costs and benefits of potential actions to choose the most appropriate one. Resolved legal issues that could be handled without the use of a defense attorney. Negotiated with the claimant to settle the claim.
6-10 years of experience
Responsibilities: Conduct fact-based investigations to finalize legal liability for single to multivehicle accidents. Analyze and negotiate percentages of liability with other insurance carriers. Ensure compliance with state statutes and regulations. Manage a large quantity of accident claims through self-motivation and organized multi-tasking.
.
- Awarded each year for outstanding customer service at HIG's annual awards luncheon.
- Developed claim macros and tools that improved efficiency and reduced process variances.
- Served on HIG's Indianapolis Work Environment Committee.
- Recognized for bringing resolution to difficult files while retaining customer loyalty.
10+ years of experience
Evaluated and assessed claims from initial report to settlement
- Compiled claim file, conducted research, and maintained timely updates to files
- Assigned and dispatched outside adjusters, vendors, and contractors
- Ordered and requested legal documents from insured and police reports from law enforcement
- Completed claim handling in accordance with the insurance regulation laws and state specific laws including but not limited to licensed states.
- Processed, drafted, and issued settlement payments to insured's', vendors, contractors, and claimants'
- Mailed settlement payments with drafted letter and claim summary documents.
6-10 years of experience
Carmel, IN 2/2004-7/2013
Division of CNO Services, L.L.C., providing products and services in heart/stroke, cancer, accidental injury and Medicare supplemental insurance for individuals.
Claim Adjuster I
Processed and authorized payment of individual health insurance claims up to the authorization limit, specifically claims arising from heart disease, heart attack or stroke, including, but not limited to, the following:
- Interpreted the provisions of various types of health insurance policies to determine whether benefits may be paid on claims as submitted.
- Initiated investigations on contestable or unusually large claims to determine the validity of all expenses submitted for reimbursement.
- Demonstrated working knowledge of Microsoft Word, Excel and Outlook as applicable in the claims area.
0-5 years of experience
10/00-03/02
- Managed/Monitored and Negotiate Liability and Personal Injury Protection Claims.
- Accomplished quality customer service on all levels of claim assignments
- Successfully monitored High volume queue-call phone system
- Pending files controlled at 80-90 claims with increased prioritization, detail-orientation, consistent follow-up with insured and claimant customers
- Dispute resolution and liability negotiation
- Electronic claim processing, management, payments, and customer correspondence
10+ years of experience
Provided exceptional customer service while investigating, evaluating and resolving automobile property claims
- Conducted recorded interviews from all parties involved to determine the facts of the claim
- Created and processed documents per company and state regulations
- Monitored case reserves in a timely and accurate manner
- Negotiated liability and moved claims to closure
- Monitored files for special investigation referral
- Prepared file for subrogation
- Addressed third party arbitrations
- Mediated surcharge and small claims hearings as needed
0-5 years of experience
Investigated personal line claims by interviewing all parties involved to determine the extent of the company's liability.
- Secured written or taped statements from insureds, claimants, witnesses and prepared reports of their findings.
- Processed PIP claims for the state of Delaware and Maryland.
- Handled litigation on moderate exposure cases. Developed litigation plan with staff or panel counsel
6-10 years of experience
Set up workman compensation claims for at least 20 injured employees on a daily basis. Analyzed claims to determine extent of company's liability, made approval or denial decision and discussed with providers type of treatment in accordance with New York State Worker's Compensation Law. Authorized treatment through interactive conversation. Corresponded with claimant verbally and writing to explain their right as an injured employee.
- Achieved the highest number of audit by successfully communicating with physicians, claimant, co-workers, HR personnel and other agencies.
- Organizational skills as evidence by the ability to manage and prioritize tasks in a fast paced environment.
- Maintained quality rating of 95% in file handling and claims resolution.
0-5 years of experience
Key Responsibilities and Accountabilities:
- Obtained information and maintained records of accidents or personal property losses for policyholders/claimants
- Arranged appraisals, reviewed appraisal reports
- Communicated with policyholders, claimants, attorneys, physicians, medical providers, and repair shops
- Identify/refer potential fraudulent claims to SIU
- Assess liability and compensability as well as explain denial of claim
- Updated status notes, established target dates, released payments on an automated system, referred claims to SUBRO department
- Assisted total loss claims personnel in obtaining proper documentation and following processes when a vehicle deemed total loss
0-5 years of experience
- Develop skills and acquire knowledge necessary to investigate and resolve non-injury liability claims
- Investigated, evaluated, negotiated and determined proper policy coverage
- Prepare files for reassignment
- Submitted administrative reports as required
0-5 years of experience
Resolution of complex Personal &Commercial Auto and General Liability losses in Utah, Idaho, Oregon & Washington.
- Highly proficient managing litigated cases toward successful completion.
- Proactively provided summaries of state laws of all 50 states to benefit MOE's future expansion needs
- Self motivated & Directed enrollment in CE requirements for adjuster licensure
- Proficient in performing coverage analysis, directing coverage counsel and drafting reservation of rights.
10+ years of experience
Reliable, in excess of 25 years experience problem solving and assisting customers. Adept at resolving difficult situations and coordinating between a diverse customer base and executives/upper management. Complete tasks assigned achieving or exceeding company goals. Work well with fellow team members and self directed. Pairing common sense with good communication to resolve issues. Remain calm and professional throughout all customer contacts. Experience working with a diverse group of customers, as well as executives and upper management.
- Extensive Customer Service to clients: Entrusted with complex customer issues as a result of the ability to promptly resolve concerns and satisfy customers. Keep them current on status of claims investigation, police coverage and decisions on cases.
- Investigated for details on retail, commercial auto liability and general liability claims to better evaluate and come to a resolution of the case
- Maintain well organized records for easy interpretation. Enter notes on strategy of claims handling, and new information from investigation
- Autonomously manage claims from inception to completion
- Developed and delivered training classes on company procedures and state laws on handling claims
0-5 years of experience
Fort Lauderdale, FL February 2009-February 2013
- Responsible for managing a team of property claims adjusters, and serving as the primary liaison between staff and insured's.
- Provided technical guidance and direction to staff members.
- Handled direct adjustment of claims, including evaluating and negotiating settlements.
- Recommend reserves and authorize payments within scope of authority.
- Investigated claims to determine validity and potential fraud.
- Assigned and managed defense counsel for sinkhole neutral evaluations and civil remedy notices.
0-5 years of experience
Review automobile property damage claims for policy holders and their claimants throughout the United States.
- Interview, telephoned, and corresponded with policy holders and claimants.
- Inspect property damage to determine extent of company's liability by creating an estimate of damages using a computerized estimating system.
- Increase operational effectiveness by effectively and successfully managing multiple claims assignments per day.
- Awarded three times the Gold Award for exceptional customer service.
- Manage the claims process until all repairs have been completed and the customer is totally satisfied.
- Provide excellent customer service and ensure maximum customer satisfaction.
0-5 years of experience
Receive daily claims, contact and interview the insured to obtain pertinent information surrounding property loss or damages.
- Worked together with independent adjusters and field adjusters.
- Review and analyzed assigned policy forms and reports to determine coverage and carriers liability.
- Set up EUO's for further investigation with our attorneys
- Managed over 80 active files
- Closing production rate of 70-80%
- Negotiated claims by 50%
- Worked closely with attorneys, engineers, experts to obtain expert opinions and recommendations.
- Attended depositions as a company representative
0-5 years of experience
Responsible for investigating and settling auto claims for New York State losses.
- Maintained an organized work flow to maintain high expectations of my duties.
- Used my knowledge of the claim system to keep in constant contact with my current claims and to promptly address any issues that may arise.
- Maintained a positive rapport with all current and potential future customers.
0-5 years of experience
Prepare personal injury/liability/work comp claims for settlement
- Solve any billing/payment issues on insurance claims
- Medically managed files, compiling & reviewing bills/records/wage information Scheduled appointments & back up receptionist on multi-line switchboard
- Updated medical treatment information & provided status updates
6-10 years of experience
Key Accomplishments:
- Managed commercial field claims for the [company name].
- Completed field investigation, negotiation and settlement of commercial hurricane claims.
- Negotiated with insured's public adjusters and plaintiff's attorneys to reach settlements.
- Practiced in mediation and appraisal with corporate legal representatives.
- Serviced claims of up to $1M or more.
0-5 years of experience
Promoted twice in a 10 month period
- Consistently exceeded monthly goals for contact, and pending reduction
- Member of recognition committee from January 2001 to January 2002
- Investigate claims, obtain recorded statements of all parties, order police reports
- Ability to recognize fraudulent claims and channel them to SIU
- Explain Comparative Negligence and Insurance vernacular to policy holders
- Handled both Standard and Non-Standard book of business for 6 states
10+ years of experience
Investigated, evaluated and settled claims, applying technical knowledge and human relation skills to affect fair and reasonable settlement of claims with prompt settlement of cases and contributed to a reduced loss ratio.
- Managed claim files with file inventory of approximately 115-120 files, First and Thirty-Party Auto Casualty, Business Lines, Homeowners Liability, and Worker's Compensation liability.
- Settled claims directly with customers and attorneys.
- Managed injury claim files including medical records requiring detailed analysis.
- Adjusted reserves or provided recommendations to ensure that reserve activities are consistent with corporate policies.
- Recognized potentially fraudulent claims and contacted the appropriate in-house personnel to respond.
- Contributed to team environment by assisting with claims from other adjusters inventories in their absence.
- Claim payments, changed reserves and new claims on computer system, input concise yet sufficient file documentation.
- Conferred with legal counsel on claims requiring litigation.
- Proficient working knowledge of desk top and lap top computers. Microsoft Word, latest edition of 2011.
0-5 years of experience
Investigate, evaluate, estimate, negotiate, and settle property claims in an office setting.
- Created property repair estimates created in Xactimate based on phone scoping.
- Reviewed property damage estimates created by field estimators for completeness and accuracy.
- Make decisions that impact individual customers and groups of customers.
- Typically the Company's primary claim contact with impact on customer perceptions of the Company.
0-5 years of experience
Interim Claim Unit Supervisor during staffing reorganization and also during supervisor absences.
- Audit appraisals from body shops, independent appraisers, and claimant carriers for accuracy, cost effectiveness, and state and corporate compliance. Effectively negotiate adjustments.
- Responsible for timely completion of assigned damage appraisals on vehicles such as but not limited to automobiles, motorcycles, heavy duty trucks, recreational vehicles, and trailers.
- Management of a pilot third party administered Direct Repair Program in Arkansas.
- Negotiate total loss settlements and manage salvage. Train appraisers in negotiating total loss settlements.
0-5 years of experience
Planned and scheduled work associated with processing complex claims and handled diverse case load.
- Proactively scheduled work required to investigate / process claims and determine accurate loss payment.
- Effectively collaborated with a diverse group of professionals to ascertain expert evaluations of claims and defend insurer's position on settlements.
- * ** **
0-5 years of experience
Investigation of multi-line and general liability claims, primarily working from home
- Evaluation of claims and negotiation of settlements on behalf of Alterra Insurance
- Handled general liability claims for commercial risks including slip and falls, assault and battery, false arrest, wrongful entry, wrongful detention, dram shop cases, discrimination, etc, many of which involved catastrophic injuries
- Ability to interpret coverage and address coverage issues
- Compose and issue disclaimer or reservation of rights letters
- Constant monitoring of reserves for new developments to adjust accordingly
- Extensive experience identifying contractual obligations for potential tender of claim
- Handled all administrative functions such as issuing payments, adjusting reserves, tender letters, large loss reports, releases and other general correspondence
- Assigned new lawsuits, established litigation budget and plan of action, summarized discovery and monitored for potential to settle
- Attended mediations and trials with settlement authority in excess of $500,000
0-5 years of experience
Verified validity, analyzed payment and agent liability on claims submitted
- Participated in peer coaching
- Implemented all MAGIC training into phone calls with customers, clients, agents, and interoffice personnel
- Member of a process review initiative that renovated and automated processes in the claims department.
- Liaison between claims and the IT departments to ensure the new processes were implemented accurately
- Conceptualized and developed procedures for a paperless work flow
- Utilized lean thinking to revitalize procedures in the claims department including paperless procedures
- Participated in developmental training to learn about and utilize customer service oriented skills
10+ years of experience
2000 - Present, The Hartford
- Perform scoping and estimating in Southwestern United States with an emphasis on residential property claims.
- Provide assistance and guidance to several independent insurance adjusters related to evaluation of construction specifics and estimating of damages.
- Provided consulting to independent adjusters for written reports to be presented to insurance carriers.
- Currently licensed in 17 states.
6-10 years of experience
and handled claims in a seven (7) state area. I was primarily responsible for the following:
- Responding to claims in a timely manner and setting reserves;
- Obtaining medical records and preparing summary of same;
- Completing an investigation based upon witness statements and police report;
- Determining liability based upon comparative negligence laws;
- Evaluating damages based upon special and general damages obtained;
- Negotiating claim on behalf of the insured throughout a series of settlement negotiations with plaintiff's attorney and/or mediator; and • Monitoring trial proceedings
0-5 years of experience
Administers and manages General Liability, Auto Liability for both property damage and personal injury claims along with Product Liability Chemical Exposure such as Benzene claims. Asbestos and Pollution Claims for National Commercial Accounts.
- Prepares client and excess carrier reports.
- Handles claims which are in litigation and understands legal concepts of policy and explanation of complex claim settlements.
- Prepares and presents files for claim reviews and settlement authority.
- Handle First Party Property Damage and subrogation.
- Adept in multi-tasking environment requiring prioritization, organization, and sustained follow-through.
- Conducted outside investigations when necessary/plausible.
- Have attended or participated in mediations when required.
6-10 years of experience
Handle New York and Delaware No Fault Claims
. Review coverage and determine eligibility
. Set up No Fault claim
.Contact claimants and explain coverage
. Monitor claim and follow up with claimants on their treatment
. Identify possible fraud cases and refer to investigating department
. Set up Independent Medical Examinations and Peer Reviews
. Communicate with claimants or attorney
. Completing NF10 forms and sending delay letters
. Calculating wages and mileage
. Issuing payments for wages, mileage, household
assistance and any out of pocket expenses
. Setting upMed Approval with instructions on processing the medical bills for each claim
Medical Bill Examiner
- Make payments to providers for medical bills relating to auto accidents
- Review bills and compare to Eob's to ensure all information including ICD9 and CPT codes are correct
- Customer Service; answering all provider questions regarding medical bills
- Ensure bills are paid in a timely manner to maintain regulatory compliance Continuously achieve production score
10+ years of experience
Supervisor of first reports department, leading a team of 5-6 employees.
- In charge of distributing and monitoring the workload of the first reports team.
- Managing all incoming claims department documents via email and fax.
- Performing liability investigations per company and industry guidelines.
- Being observant of fraud indicators.
- Reviewing estimates.
- Approving and issuing payments.
10+ years of experience
Southfield, MI
(currently Sedgwick, previously QBE Insurance 2003-Present
Investigation of first and third party litigated and non-litigated high-risk automobile claims.
- Maintain Michigan PIP claim files in accordance with the Michigan No-Fault Law including catastrophic claims.
- Attend depositions, settlement conferences and facilitations.
- Interact with attorneys, providers, case managers and other top professionals in the field.
- Communicate with the policyholder to ensure quality customer service.
- Evaluate third party losses and prepare settlement negotiations.
- Report to MCCA and re-insurers.
0-5 years of experience
Utilized Diamond and Xcelys to process out-of-network providers'
claims at PPO level
- Interpreted related policies and procedures to ensure Dell's
- Monitored, analyzed, and updated Dell's compliance actions in reference to new and evolving benefit legislation
- Served customers ranging from world's largest businesses and public-sector organizations, to small and medium businesses, and
- Met and exceeded set standard of 85 claim adjustments per day while maintaining 95% accuracy
0-5 years of experience
- Handled Auto Liability Claims including Attorney Represented - Gathered and analyzed required data to complete investigations and make informed decisions.
- Negotiated, settled and closed claims.
- Determined and informed claimants of final decision on liability.
- Aggressively Investigate Claims, determined Coverage, and established Liability.
0-5 years of experience
- Investigated, evaluated and settled low to moderately complex 1st and 3rd party automobile,
- Completed coverage and liability investigations
- Managed use of and expense of outside vendors
- Complied with same day/next day telephone contact in accordance with Best Practices
- Obtained facts to evaluate coverage, negligence, medical necessity and causation/damages
- Reassigned claims involving injury to appropriate No Fault/Casualty Claims Departments
- Identified subrogation opportunities; handled adverse subrogation and arbitration
0-5 years of experience
- Handled Auto Liability and Homeowners Claims - Gathered and analyzed required data to complete investigations and make informed decisions.
- Negotiated, settled and closed claims.
- Determined and informed claimants of final decision on liability.
0-5 years of experience
Multi-line Claims Adjuster - Auto/Property
- Investigated, evaluated and settled claims according to policy coverage and limits and monitored daily to ensure prompt
- Set and adjusted reserves in order to pay and process claims within set authority levels.
- Resolved multiple, complex, severe exposure claims by using high service oriented skills, understanding of policy
0-5 years of experience
Responsible for incoming claims and acquiring the facts of loss from all claimants involved while showing
empathy and care.
- Completed an investigation of the claims in order to determine the percentage of liability.
- Once liability has been determined review any injuries and made final settlement payments up to 15,000 bodily
- Received multiple customer service awards
0-5 years of experience
Receive first notice of loss on property theft and structural claims from minor to severe in complexity
- Review incoming estimates from mitigation vendors as well as independent
- Communicate coverage and any limitations with policyholders and related
- Consistently maintain the required metrics in all facets of my position such as maintaining eight hour first contact window, 88% monthly claim closure average, and positive "net promoter" customer surveys.
- Assist in the training and development of newly hired employees.
Insurance Cover Letter Examples
