ALANNA TOOKE
806 NE 7th Ave Gainesville,FL.
Summary
Results-oriented claims professional with extensive experience in claims management and auditing. Strong analytical skills and technical proficiency in evaluating coverage and negotiating settlements. Committed to improving operational processes and ensuring high levels of customer satisfaction..
Overview
24
24
years of professional experience
Work History
Technical Claims Specialist
Applied Claims Group/Risk Theory
09.2022 - Current
- Analyze insurance policies to accurately assess coverage and obligations, ensuring regulatory compliance.
- Investigate complex claims from initial notice to resolution, gathering comprehensive documentation.
- Evaluate claim damages, setting reserves based on thorough investigation and updated insights.
- Mentor new associates in best practices and industry compliance standards.
- Manage a high volume of claims, resolving issues and escalating complex matters efficiently.
- Maintain detailed calendar to ensure timely completion of daily tasks.
Commercial Claims Specialist II
Nationwide Insurance
04.2019 - 08.2022
- Managed Auto and General Liability cases, including attorney files and pro se exposures, while minimizing expenses.
- Investigated coverage and liability issues through thorough research and analysis.
- Assessed validity of injury and property claims, negotiating resolutions with customers and attorneys.
- Prepared detailed file summaries of coverage, investigations, and evaluations for leadership review.
- Maintained departmental operations as acting manager during manager's absence, ensuring continuity.
Claims Quality Assurance Specialist III
Nationwide Insurance
08.2016 - 04.2019
- Managed daily operations and administrative tasks in manager's absence, ensuring workflow continuity and productivity.
- Exercised independent judgment as temporary authority to address urgent issues promptly.
- Provided feedback on risk identification from internal audit and zone calibration reviews.
- Ensured adherence to audit schedules, special review assignments, and claim manager calibration timelines.
- Sustained individual productivity targets aligned with assessment expectations.
- Produced detailed, thorough, and relevant file review documentation meeting quality standards.
- Maintained technical expertise in claims expectations and best practices.
- Participated actively in team calibration sessions to enhance overall performance.
Personal Lines Claims Specialist III
Nationwide Insurance
05.2012 - 08.2016
- Managed pending litigation cases, large loss, and attorney file exposures while controlling expenses and minimizing potential excess exposure losses.
- Conducted complex coverage and liability investigations across Florida, Alabama, Mississippi, Georgia, Tennessee, Arkansas, and Kentucky.
- Investigated, evaluated, and negotiated resolutions for moderate to severe bodily injury and litigation claims.
- Compiled comprehensive file summaries detailing coverage, investigation results, evaluations, and litigation for leadership review.
- Assumed acting manager role during manager's absence, maintaining departmental operations.
Personal Lines Claims Specialist II
Nationwide Insurance
10.2007 - 05.2012
- Managed pending claims, including large loss and non-injury/injury exposures, while controlling expenses.
- Evaluated and negotiated injury and homeowner claims to reach favorable conclusions.
- Trained new staff on claims procedures and industry best practices.
- Communicated with customers and attorneys to assess claim validity effectively.
- Assumed acting manager role during manager's absence, maintaining departmental operations.
Personal Lines Master Claims Associate
Nationwide Insurance
06.2005 - 10.2007
- Resolved bodily injury personal lines liability claims through telephone, internet, or in-person interactions.
- Provided exceptional service by promoting Nationwide's “On Your Side” customer commitment.
- Investigated complex coverage issues, determining applicable policy coverages and addressing material misrepresentation.
- Recommended appropriate reserve amounts following comprehensive evaluations of each claim.
- Managed daily operations and administrative tasks in manager's absence, ensuring workflow continuity and productivity.
Personal Lines Senior Medical Claims Associate
Nationwide Insurance
09.2004 - 06.2005
- Evaluated Personal Injury Protection (PIP) and Med Pay claims for coverage and eligibility.
- Assessed medical necessity and appropriateness of charges per state fee schedules.
- Reviewed claim documentation for accuracy and compliance with policy guidelines.
- Assisted in training new staff on claims procedures and best practices.
- Managed a high volume of incoming calls from providers seeking assistance with submitting claims.
Personal Lines Non-Injury Claims Associate
Nationwide Insurance
04.2002 - 09.2004
- Investigated policy coverages to determine applicability for claims processing.
- Executed best practices to evaluate and settle non-injury auto and homeowner claims efficiently.
- Served as primary contact for all material damage claims, ensuring clarity and resolution.
- Assumed acting manager role during manager's absence, maintaining departmental operations.
- Promoted to Senior Claims Representative in April 2003 for outstanding performance.
Education
Bachelor of Arts - English
University of Florida
Gainesville, FLAssociate of Arts - English
Florida State University
Tallahassee, FLSkills
- Quality assurance expertise
- Investigation and negotiation
- Effective communication
- Training and development
- Customer relations
- Insurance process knowledge
- Leadership and problem-solving
Activities
Volunteers for Meals on Wheels, Alachua County Humane Society and The River Phoenix Center for Peacebuilding.
Timeline
Technical Claims Specialist
Applied Claims Group/Risk Theory
09.2022 - Current
Commercial Claims Specialist II
Nationwide Insurance
04.2019 - 08.2022
Claims Quality Assurance Specialist III
Nationwide Insurance
08.2016 - 04.2019
Personal Lines Claims Specialist III
Nationwide Insurance
05.2012 - 08.2016
Personal Lines Claims Specialist II
Nationwide Insurance
10.2007 - 05.2012
Personal Lines Master Claims Associate
Nationwide Insurance
06.2005 - 10.2007
Personal Lines Senior Medical Claims Associate
Nationwide Insurance
09.2004 - 06.2005
Personal Lines Non-Injury Claims Associate
Nationwide Insurance
04.2002 - 09.2004
Bachelor of Arts - English
University of Florida
Associate of Arts - English
Florida State University