Aquilla McClearn

• Evaluated claims to determine validity and coverage under policy terms.
• Conducted thorough investigations to gather evidence and assess damages accurately.
• Ensured compliance with state regulations and company policies through diligent review of all claim-related materials.
• Assisted clients in understanding their insurance coverage by explaining complex terms and conditions clearly and concisely.
• Improved claim processing efficiency by conducting thorough investigations and promptly addressing indicators.

• Researched claims and incident information to deliver solutions and resolve problems.
• Analyzed information gathered by investigation and reported findings and recommendations.
• Reviewed questionable claims by conducting agent and claimant interviews to correct omissions and errors.
• Identified suspicious losses and contacted manager for investigative assistance.
• Maintained detailed records of all case-related activities, ensuring accurate documentation for auditing purposes and future reference.
• Minimized company exposure to financial risk by diligently identifying fraudulent claims and coordinating with legal teams for resolution.
• Provided exceptional customer service during stressful situations, demonstrating empathy, patience, and professionalism throughout the entire claims process.
• Served as a subject matter expert within the company for complex claims issues, providing guidance and support to colleagues when needed.
• Improved team productivity, providing comprehensive training to new adjusters on industry best practices and company guidelines.

• Examined claims forms and other records to determine insurance coverage.
• Read over insurance policies to ascertain levels of coverage and determine whether claims would receive approvals or denials.
• Delivered exceptional customer service to policyholders by communicating important information and patiently listening to issues.
• Reviewed police reports, medical treatment records and physical property damage to determine extent of liability.
• Researched claims and incident information to deliver solutions and resolve problems.
• Identified insurance coverage limitations with thorough examinations of claims documentation and related records.
• Investigated and assessed damage to property and reviewed property damage estimates.
• Reviewed new files to determine current status of injury claim and to develop plan of action.
• Maintained contact with claimants and attorneys to determine treatment status.
• Analyzed information gathered by investigation and reported findings and recommendations.
• Reviewed questionable claims by conducting agent and claimant interviews to correct omissions and errors.
• Optimized workload efficiency through prioritization of tasks based on claim complexity and time sensitivity.
• Developed strong working relationships with third-party vendors such as appraisers, repair facilities, and medical experts to ensure accurate evaluations of loss events.
• Reduced fraud losses through diligent investigation of suspicious claims and collaboration with law enforcement agencies.
• Participated in ongoing training programs to continuously maintain knowledge of current industry trends and regulatory changes impacting casualty adjusting practices.

• Successfully identified and investigated several multi-claim fraud rings, saving the company over $500,000.
• Investigated and analyzed complex coverage issues and claims referred to the Special Investigative Unit for potential fraud.
• Conducted prompt and thorough investigations on referred files.
• Performed thorough investigations including; background investigations, discussions with agency and underwriting and conducting in-depth interviews with insureds', claimants, witnesses, law enforcement and other carriers as warranted.
• Prepared investigative action plans, summary of key findings, and closing reports.
• Interviewed insured, witnesses, agents, claimants and service providers to correct errors or omissions, ascertain critical details and investigate questionable claims.
• Reviewed and analyzed suspicious and potentially fraudulent insurance claims.
• Collaborated with industry anti-fraud organizations to resolve claims.
• Analyzed information gathered by investigations to report findings and recommendations.
• Reviewed police reports, medical treatment records and physical property damage to determine extent of liability.
• Eliminated claimant, premium and provider fraud.
• Trained other claims staff members on proper handling and evaluation of suspicious and potentially fraudulent claims.

(Property Damage, Total Loss and Bodily Injury).

• Examined claims forms and other records to determine insurance coverage.
• Conducted full claim investigations and reported updates and legal actions.
• Investigated and established disputed liability.
• Applied claim settlement procedures to process claims, initiate claim payments and close claim files.
• Organized and prioritized work on a constant basis while meeting deadlines and managing changing priorities effectively.
• Reviewed and analyzed suspicious and potentially fraudulent insurance claims.
• Reviewed police reports, medical treatment records and physical property damage to determine extent of liability.
• Trained other claims staff members on proper handling and evaluation of injury claims.
• Conducted interviews of witnesses and claimants to gather facts and information.

• Provided friendly assistance with applicants and new hires throughout interviewing and hiring process.
• Assisted human resources and recruiting teams by scheduling phone screens and on-site interviews.
• Created and updated tracking spreadsheets using MS Office.
• Worked with Staffing System, eSkills and Aon Gate.