Ashley Traylor
Cypress,United States
Summary
Professional claims specialist with strong record in handling and resolving complex claims efficiently. Adept at analyzing data, identifying discrepancies, and providing solutions that drive positive outcomes. Effective team collaborator with focus on achieving results and adapting to evolving requirements. Skilled in negotiation, customer service, and regulatory compliance, consistently ensuring accuracy and fairness.
Overview
15
15
years of professional experience
1
1
Certification
Work History
Claims Specialist
VoltaGrid
12.2024 - Current
- Enhance customer satisfaction with timely communication, empathy, and clear explanations of claim outcomes.
- Manage a high volume of claims effectively by prioritizing tasks and maintaining excellent organizational skills.
- Develops strong working relationships with external partners such as adjusters, legal counsel, and medical professionals to facilitate efficient claim resolution processes.
- Settles complex claims fairly by applying critical thinking, negotiation skills, and detailed knowledge of insurance policies.
Claims Consultant
Brady, Chapman, Holland & Associates
12.2023 - 12.2024
- Reviewed, analyzed, and processed, when applicable, the first notice of loss on behalf of the client to the insurance carrier(s), including communicating the claim number and adjuster's contact information to the client.
- Monitored all open claims activity, assisted as needed to ensure the client's needs were met and the claim was brought to a conclusion promptly.
- Prepared Best Claims Handling reports and attended and assisted with regularly scheduled client presentation meetings.
- Prepared and distributed internal Large Loss Alerts for all catastrophic events and claims that resulted in a fatality and or losses with reserves > $100,000.
- Maintained BCH systems, including document management, according to BCH policies and procedures.
- Effectively utilized, and managed WorkSmart/ ImageRight tasks according to BCH procedures.
- Provided expert advice on coverage limits and exclusions, helped clients make well-informed decisions about their insurance needs.
ESU PD Adjuster (Contract)
Trexis Insurance
08.2023 - 11.2023
- Analyzed and processed claims through well-developed action plans to ensure efficient and timely resolution by investigating and gathering information to determine the exposure of the claim
- Estimated cost of medical treatment, or compensation for injured parties involved in accidents
- Interpreted medical reports, reviewed medical billing, evaluated claim value, and managed claims process to ensure efficient resolution
- Directed claims negotiations within allowable limits and supported successful litigations for advanced issues.
Independent Insurance Adjuster
Renfroe
10.2022 - 08.2023
- Examined claims forms and other records to determine insurance coverage
- Verified insurance claims and determined a fair amount for settlement
- Evaluated insurance policies and analyzed damages to determine coverage
- Answered customer questions regarding deductibles
- Reviewed police reports, medical treatment records, and physical property damage to determine the extent of liability
- Documented all investigation activity and presented reports to management.
- Directed claims negotiations within allowable limits and supported successful litigations for advanced issues.
Vertical Delivery Recruiter (Finance & Accounting)
Kforce Inc
04.2022 - 04.2023
- Conducted resume review and assessment based upon SLOMA (Skills, Location, Opportunity, Money, and Availability) criteria to determine candidate suitability/viability
- Segmented, organized, and prioritized candidates according to the degree of alignment with position requirements
- Determined candidate compensation expectation of maximizing probability
- Conducted reference checks, background screening, and other pre-employment checks to verify information on applicant's resume.
- Managed high-volume requisitions in a timely manner to meet client staffing needs efficiently.
- Enhanced recruitment process for faster hiring by utilizing various sourcing tools such as job boards, social media, and networking events.
- Provided exceptional customer service to both candidates and clients, fostering long-term partnerships.
- Studied job descriptions and qualifications to determine applicant requirements.
- Created engaging job postings that accurately reflected position requirements while showcasing company culture.
University Relations Recruiter II
Lumen Technologies
08.2021 - 03.2022
- Conducted phone interviews to assess applicants relevant knowledge, skills, experience and aptitudes.
- Conducted reference checks, background screening and other pre-employment checks to verify information on applicant's resume.
- Coordinated schedules to arrange management interviews with applicants.
- Managed high-volume requisitions in a timely manner to meet client staffing needs efficiently.
- Enhanced recruitment process for faster hiring by utilizing various sourcing tools such as job boards, social media, and networking events.
- Studied job descriptions and qualifications to determine applicant requirements.
- Created engaging job postings that accurately reflected position requirements while showcasing company culture.
- Developed strong understanding of industries served, allowing for targeted recruiting efforts for specialized positions.
- Operated and maintained applicant tracking and candidate management systems.
- Partnered with HR teams to determine workforce planning needs, aligning recruitment efforts with business objectives.
Claims Adjuster
Progressive Insurance
10.2016 - 12.2020
- Interviewed policyholders, witnesses and third parties to gather information and details regarding injury events
- Evaluated coverage, liability and damages and investigated suspicious claims
- Interpreted policy details and recommended most favorable course of action
- Interviewed relevant parties to determine claim denial or settlement
- Negotiated favorable settlements with claimants, attorneys, and other insurance carriers to minimize financial risk for the company.
- Referred extreme cases to the Special Investigation Unit (SIU) for further review
- Examined claims forms and other records to determine insurance coverage.
- Prepared reports of findings in investigations.
- Verified insurance claims and determined fair amount for settlement.
- Maintained compliance with state regulatory requirements through meticulous documentation and adherence to company policies.
- Conducted thorough investigations of complex insurance claims, gathering evidence and analyzing relevant documentation.
District Parole Officer II
Texas Department of Criminal Justice
07.2010 - 10.2016
- Coordinated and worked closely with law enforcement, social service agencies and mental health providers
- Served as court liaison by attending court hearings and presenting reports and recommendations
- Collaborated with institutional staff, area law enforcement, mental health boards, county attorneys and treatment providers
- Performed routine home inspections and drug tests for offenders on parole
- Reported violations of parole conditions to appropriate authorities and maintained record of case activity
- Arranged substance abuse rehabilitation for offenders.
Education
Master of Arts - MA - Sociology
Prairie View A&M University
01.2013
Bachelor of Arts - BA - Mass Communication/Media Studies
Prairie View A&M University
01.2006
Skills
- Effective insurance claims handling
- Claims Resolution
- Claims Management
- Claims analysis
- Analytical investigation techniques
- Policy Interpretation
- Claims assessment expertise
- Claims Processing
- Document analysis
- Coverage assessments
- Root cause assessment
- Analytical reasoning
- Customer service and support
- Team Collaboration
- Active Listening
- Decision-Making
- Relationship Building
- Insurance policy coverage knowledge
- Claims adjustment
- Report and Records Review
- Settlement Negotiations
Certification
- Adjuster All lines
- TWIA Claims Examiner Certification
- TWIA Field Adjuster Certification
Timeline
Claims Specialist
VoltaGrid
12.2024 - Current
Claims Consultant
Brady, Chapman, Holland & Associates
12.2023 - 12.2024
ESU PD Adjuster (Contract)
Trexis Insurance
08.2023 - 11.2023
Independent Insurance Adjuster
Renfroe
10.2022 - 08.2023
Vertical Delivery Recruiter (Finance & Accounting)
Kforce Inc
04.2022 - 04.2023
University Relations Recruiter II
Lumen Technologies
08.2021 - 03.2022
Claims Adjuster
Progressive Insurance
10.2016 - 12.2020
District Parole Officer II
Texas Department of Criminal Justice
07.2010 - 10.2016
Bachelor of Arts - BA - Mass Communication/Media Studies
Prairie View A&M University
Master of Arts - MA - Sociology
Prairie View A&M University
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