7 Years Claims Adjuster, Personal Banker and Subject matter expert in banking . 4 years Bank Anti-Money Laundering (AML) experience Results-oriented Claims Adjuster Background includes criminal investigation, insurance fraud and surveillance. SUI Investigator successful at collecting and compiling information in line with rules of evidence. Scrupulously fair and honest. To seek and maintain full-time position that offers professional challenges utilizing interpersonal skills, excellent time management and problem-solving skills. Claims Investigator offering 7 dedicated to completing thorough, timely investigations.
• Investigate claim damages and situation using internal and external resources. Investigation steps include speaking with the insured or other involved parties such as contractors, requesting and receiving a field investigation report, research on past claim activity, research on external websites for CAT event confirmation, and engaging vendors for services, material supply and/or pricing.
• Determined policy coverage through analyzing investigation data and policy terms, including whether claim will be approved or denied. Notified insured of coverage or any issues. Establishes reserve levels at the beginning of handling a claim and adjusts as appropriate based on investigation findings.
• Handled and owned claims submitted by independent adjusters, including making coverage and reserve decisions, and reviewing work for accuracy.
• Maintained accurate and current communication with insured/claimant.
• Maintained accurate and current claim file documentation throughout the life cycle of claim cases.
• Investigate commercial claim damages operated estimates in Symbility system
• Investigation steps include speaking with the insured or other involved parties such as contractors, requesting and receiving a field investigation report, research on past claim activity, research on external websites for CAT event confirmation, and engaging vendors for services, material supply and/or pricing.
• Determined policy coverage through analyzing investigation data and policy terms, including whether claim will be approved or denied. Notified insured of coverage or any issues. Establishes reserve levels at the beginning of handling a claim and adjusts as appropriate based on investigation findings.
• Handled and owned claims submitted by independent adjusters, including making coverage and reserve decisions, and reviewing work for accuracy.
• Maintained accurate and current communication with insured/claimant.
• Maintained accurate and current claim file documentation throughout the life cycle of claim cases.
• Engaged specialized departments such as Special Investigation Unit and Subrogation as appropriate.
• Determined and negotiated settlement amounts for damages claimed within assigned authority limits. Made recommendations to management for settlement amounts outside of authority limits. Closed claim files upon completion of final payment.
• Alerted underwriting, marketing and/or risk management regarding questionable risks encountered to ensure potential hazards are clearly documented.
• Reviewed recommendations for causation, approval / denial made by Independent Adjusters to determine whether to approve / deny the claim. Approves recommendations for reserve and settlement/payment schedule amounts.