Afshin Dadforouz

investigation, evaluation and negotiation of lower complexity claims in compliance with established company technical and customer service best practices.

Responsibilities included the following:

Communicate and interact with a variety of individuals including insureds and claimants.

Explained benefits, coverages, fault and claims process either verbally or in writing in compliance with regulatory and statutory requirements.

Conducted phone investigations to determine liability and damages. Identify and obtain statements from insureds, claimants and witnesses.

Negotiate within settlement authority with insureds and claimants to resolve first and third-party claims.

Handled administrative functions, update database production reports, and document and update claim files via company systems, i.e. CACS, HUON, HOC, etc.

Verify and interpret/resolve coverage by gathering necessary information to ensure policy applicability.

• Coordinate with internal and external departments as required.
• Managed complex claims by evaluating damages and determining liability to ensure fair settlements.
• Mentored junior adjusters, providing training on best practices and company policies for effective claims processing.
• Collaborated with legal teams to gather necessary documentation, enhancing accuracy in claim resolutions.
• Analyzed trends in claims data to identify potential fraud and mitigate financial losses for the organization.
• Reviewed policy language regularly to maintain a comprehensive understanding of coverage limitations and exclusions.

• Handling inbound/outbound calls and answering questions from members interested in life insurance

and financial products.

• Quoting and preparing life insurance policies.
• Preparing changes to life insurance policies including; change of beneficiary, change of ownership and

upgrade in amount or type of policy.

• Assisting clients in processing claims.
• Arranging appointments with members and prospective members regarding life insurance and financial

products.

• Participating in community and business activities and events to prospect for potential membership

and insurance sales opportunities.

• Utilizing a variety of methods in performing research leading to the establishment of high potential

prospects for AAA products. These methods include direct mail, referral systems, associate cross-selling,

partnership sharing, prospect purchases, etc.

• Contacting and qualifying prospective members and explaining features and benefits of life insurance

policies offered, suggesting amount and type of coverage based on analysis of prospect's circumstances.

• Calculating and quoting premium rates for specific policies.
• Anticipating future needs and calling on established clients to renew and upgrade accounts.
• Analyzed client needs to provide tailored life insurance solutions.
• Educated clients on policy features, benefits, and claims procedures.
• Trained junior staff on compliance standards and best practices in insurance sales.