Ayesha Dinkins
Richmond,VA
Summary
Experienced claims professional with an objective mindset focused on efficiently managing litigation cases and claims settlements. Methodical and consistent with a superior work ethic.
Versatile Senior Resolution Manager bringing 16-year career in field. Vast experience in claims investigations, financial calculations and self-directed management of complex cases. Sound judgment with analytical approach.
Overview
18
18
years of professional experience
Work History
Senior Resolution Manager
Gallagher Bassett
Rolling Meadows, IL
06.2023 - Current
- Reviewed and analyzed insurance claims to determine validity, completeness, accuracy, and eligibility for payment.
- Investigated complex or high-value claims to identify discrepancies and fraud indicators.
- Processed payments for valid claims according to established procedures.
- Facilitated communication between claimants, providers, attorneys, adjusters, employers, and other parties involved in a claim.
- Interpreted legal documents related to claims processing such as contracts and policy language.
- Maintained detailed records of all claim activities including notes about conversations with claimants or representatives.
- Provided customer service by responding promptly to inquiries from claimants regarding their benefits or coverage.
- Advised management on potential changes needed in policies or procedures based on findings from investigations.
- Planned and conducted investigations of claims to confirm coverage and compensability.
- Established proof of loss by studying documentation and assembling additional information from outside sources.
- Assessed and conducted negotiations within authority limits to settle claims.
- Conducted interviews with involved claims parties and witnesses to gather detailed information and arrange investigations.
- Contacted injured parties and legal representatives to negotiate final settlements for claims.
- Reviewed and monitored court orders, filings, pleadings, motions, briefs, and other documents.
- Attended mediations and arbitrations when necessary to resolve disputes between parties.
- Managed complex litigated claims
- Managed mid-complex claims
- Investigated insurance claims, reviewed coverage and liability, prepared reports and recommended payment or denial of claims.
- Analyzed facts of loss including photographs, diagrams and other evidence to identify potential sources of recovery.
- Negotiated settlements with claimants or their representatives in order to resolve disputes quickly and economically.
- Conducted interviews with claimants, witnesses and medical professionals to obtain additional information about the claim.
- Determined reserves for each claim based on estimated costs of settlement or defense.
- Presented cases at mediations or arbitrations as needed in order to facilitate dispute resolution process.
- Developed relationships with attorneys, experts and vendors in order to ensure prompt service when necessary.
- Utilized computer systems such as Microsoft Office Suite and specialized software programs used by the company.
- Adhered strictly to departmental guidelines; ensured that all activities were compliant with applicable state laws.
- Attended continuing education classes in order to stay abreast of changes in industry standards.
- Performed special projects upon request from management; completed tasks efficiently while meeting deadlines.
- Reviewed, evaluated and adjusted claims to promote fair and prompt settlement.
- Negotiated and settled claims according to information presented through reports, research and data verification.
Claims Adjuster- Construction Defects
US Administrator Claims
Oak Ridge, TN
06.2021 - 03.2022
- Worked in construction defects - Conduct thorough investigation of construction claims - Negotiate and settle property damage claims - Handled litigated claims - Products Completed Operations
- Investigated insurance claims, reviewed coverage and liability, prepared reports and recommended payment or denial of claims.
- Interpreted policy language to determine coverage for insureds under various lines of business.
- Reviewed medical records, police reports and other documents related to claim investigations.
- Conducted interviews with claimants, witnesses and medical professionals to obtain additional information about the claim.
- Analyzed facts of loss including photographs, diagrams and other evidence to identify potential sources of recovery.
- Negotiated settlements with claimants or their representatives in order to resolve disputes quickly and economically.
- Determined reserves for each claim based on estimated costs of settlement or defense.
- Presented cases at mediations or arbitrations as needed in order to facilitate dispute resolution process.
- Developed relationships with attorneys, experts and vendors in order to ensure prompt service when necessary.
- Maintained accurate documentation of all claim activity within designated system.
- Reviewed, evaluated and adjusted claims to promote fair and prompt settlement.
- Completed required investigations on referred files within established timeframes.
- Communicated with personnel and legal counsel on claims involving litigation.
General Liability Claims Adjuster
Berkshire Hathaway Guard Insurance
Alpharetta, GA
09.2018 - 06.2021
- Conduct thorough investigation of complex claims - Negotiate and settle general liability claims that range from minor exposures to more complex higher exposure claims - Communicate effectively with insureds, claimants, attorneys, and insurance agents - Handled litigated claims to completion
- Investigated and evaluated claims to determine liability and damages.
- Analyzed coverage issues, applicable laws, court decisions, and other relevant information.
- Resolved claims in a timely manner according to established procedures.
- Negotiated settlements with claimants or their representatives.
- Maintained contact with insureds, claimants, witnesses, attorneys, medical providers and others involved in the claims process.
- Prepared detailed reports of findings for management review.
- Attended mediations or settlement conferences when required by law or company policy.
- Ensured compliance with all state insurance regulations governing claim handling procedures.
- Developed relationships with outside vendors such as investigators and appraisers.
- Managed multiple caseloads simultaneously while meeting deadlines.
- Reviewed, evaluated and adjusted claims to promote fair and prompt settlement.
- Negotiated and settled claims according to information presented through reports, research and data verification.
- Completed required investigations on referred files within established timeframes.
- Conducted witness interviews to assist claim information gathering process.
- Interviewed claimants, medical specialists and employers to determine pertinent claim information.
- Delivered exceptional customer service to clients by communicating information and actively listening to concerns.
- Reviewed police reports, medical treatment records, medical bills and physical property damage to determine extent of liability.
Commercial Auto Adjuster
Hereford Insurance
Long Island City, NY
11.2014 - 09.2018
- Negotiating liability with customers, adverse carriers, and attorneys utilizing New York State Comparative Negligent Law
- Resolve coverage issues for active policies - Compose delay letters, denial letters, and
- Set up inspections for eligible vehicles
- Investigated vehicle damage, estimated repair costs and determined liability.
- Maintained detailed records of all claim activity and provided updates to management.
- Resolved disputes between claimants, insurers and third-party vendors.
- Negotiated settlements with claimants in an effort to reduce overall costs for the company.
- Assessed salvage values of damaged vehicles prior to offering a settlement amount.
- Prepared reports summarizing claim activities including expenses, payments, reserves and recoveries.
- Provided customer service by responding to inquiries from policyholders regarding their claims status.
Liability Claims Examiner
GEICO
Woodbury, NY
12.2011 - 05.2013
- Negotiating claims where there is a dispute in liability utilizing
- Comparative Negligent Law - Negotiating claims to e ect prompt and fair settlements - Negotiating with either customers directly or with adverse carriers and/or attorneys - Referring claims with Bodily Injury exposure to the appropriate claim examiner for processing.
- Prepared detailed written reports summarizing investigation results and recommended action plans.
- Monitored progress of open claims to ensure timely resolution according to company standards.
- Corresponded with claimants via telephone calls or letters regarding the status of their claim.
- Advised management on strategies for resolving difficult liability cases.
Personal Injury Protection Adjuster
GEICO, Government Employees Insurance
Woodbury, NY
08.2006 - 12.2011
- Assessed the validity of claims by obtaining information from witnesses, police reports, medical records and other relevant sources.
- Provided advice and assistance regarding legal issues surrounding personal injury protection claims.
- Ensured compliance with state regulations governing personal injury protection adjusters.
- Investigated and evaluated personal injury protection claims, verifying coverage and determining liability.
- Interpreted policy language to determine whether a claim is covered under the insurance contract.
- Examined medical records, bills, and other documents related to personal injury protection claims.
- Conducted investigations to verify facts of the incident leading to the claim.
- Determined appropriate payment amounts based on evaluation of damages and financial responsibility for losses.
Claims Service Representative
GEICO
Woodbury, NY
09.2005 - 08.2006
- Verified customer eligibility and documentation accuracy.
- Assessed claim validity and investigated discrepancies.
- Drafted correspondence to customers regarding claim status, decisions, and payments.
- Provided timely response to inquiries from customers, brokers, and internal staff.
- Maintained accurate records of all claims activities in the database system.
- Collaborated with other departments to ensure quality service delivery.
- Monitored progress of outstanding claims to ensure timely resolution.
- Educated customers on their coverage options and limitations.
Personal Injury Protection Representative
GEICO, Government Employees Insurance
Woodbury, NY
Education
BBA - Business Administration
Dowling College
Oakdale, NY06.2005
Regents Diploma -
Brentwood High School
01.2001
Skills
- Multi tasker
- Advanced Oral and Written
- Communication Skills
- Organized
- Customer Service Oriented
- MS O ce
- Advanced Computer Skills
- Negotiation Skills
- Quality Assurance
- Strong Problem Solving
- Aptitude (Lean Six Sigma)
- MS Windows Proficient
- Exceptional Communication
- Skills
- Medical Terminology
- Knowledge
- Skilled in Call Center
- Operations
- Multi Line phone operations
- Proficient
- Medical Care Evaluations
- Interpreting Coverage
- Litigation Support
- Case Settlement Abilities
- Case Management
- Claims Reviewing
- Summary Reports
- Customer Service
- Computer Skills
- Goal Setting
- Teamwork and Collaboration
- Decision-Making
- Documentation and Reporting
- MS Office
- Negotiation
- Good Judgment
- Performance Evaluations
- Work Planning and Prioritization
- Claims Processing
- Property Claims
- Risk Assessment
- Policy Investigations
- Highly Motivated
- Coverage Assessments
- Data Analysis
- Strong Interpersonal and Communication Skills
- Claims File Management Processes
- Claims Investigations
- Best Practices Implementation
- Litigation Resolution
- Report Writing
- Risk Management
- Allocating Claims
- Currently hold licenses in the following states: New York, Florida, Texas, Georgia, Washington, Connecticut, New Hampshire, South Carolina, North Carolina, California, Virginia, Vermont, Kentucky, Delaware, Louisiana, New Mexico, Nevada, Rhode Island, West Virginia
Timeline
Senior Resolution Manager
Gallagher Bassett
06.2023 - Current
Claims Adjuster- Construction Defects
US Administrator Claims
06.2021 - 03.2022
General Liability Claims Adjuster
Berkshire Hathaway Guard Insurance
09.2018 - 06.2021
Commercial Auto Adjuster
Hereford Insurance
11.2014 - 09.2018
Liability Claims Examiner
GEICO
12.2011 - 05.2013
Personal Injury Protection Adjuster
GEICO, Government Employees Insurance
08.2006 - 12.2011
Claims Service Representative
GEICO
09.2005 - 08.2006
Personal Injury Protection Representative
GEICO, Government Employees Insurance
BBA - Business Administration
Dowling College
Regents Diploma -
Brentwood High School