Bethelena Speed
Lawrenceville,GA
Summary
Driven Insurance Claims Specialist who is highly motivated, success driven with excellent organizational skills, with a strong understanding of the insurance claims handling and demonstrated knowledge of state laws, regulations and policy interpretation. Obtain facts of loss, review coverage, obtain and review evidence, determine liability, request and provided all supportive documentation.
Overview
25
25
years of professional experience
1
1
Certification
Work History
Commercial Claims Specialist
Custard Insurance Adjusters Inc.
10.2023 - 01.2024
- Recognized for continued outstanding customer service - nominated for In-Synch Award Successfully determine coverage and communicate with insured based on application of policy information, facts and allegations of each case.
- Aggressively investigate, evaluate, reserve, and negotiate assigned claims in accordance with Best Practices.
- Organize workflow to maintain efficiency and productivity.
- Recognized for successfully identifying resources for activities required to properly investigate claims involving Subrogation, Risk Control, and fraud.
- Effectively manage litigated claims.
- Maintain accounts with business partners to ensure and sustain quality results.
- Managed a high volume of claims effectively by prioritizing tasks and maintaining excellent organizational skills.
- Demonstrated adaptability by successfully managing a diverse range of claim types, including property damage, bodily injury, liability disputes, and more.
- Upheld company reputation by adhering strictly to ethical guidelines when managing sensitive cases, ensuring fair and impartial treatment for all parties involved.
- Improved claim processing efficiency by streamlining workflows and implementing time-saving strategies.
- Spearheaded internal process improvement initiatives to optimize claims handling procedures, resulting in cost savings and increased efficiency.
Senior General Liability Claims Representative
Gallagher Bassett Services, Inc
10.2003 - 01.2024
- Directly responsible for investigating general liability claims, such as slip and falls, municipality claims involving wrongful death allegations.
- Review the Policy Forms for Coverage, Endorsements and Exclusions.
- Work closely with clients to complete the investigation of claims, determine liability, and evaluate settlements.
- Investigated accidents or incidents to determine cause and extent of damages.
- Reduced company exposure to potential losses by conducting thorough investigations of each claim.
- Made contact with insurance carriers to discuss policies and individual patient benefits.
- Managed a caseload of diverse liability claims, ensuring timely resolution and accurate documentation.
- Maintained confidentiality of patient finances, records, and health statuses.
- Required to understand services offered to assist in outside sales presentations.
- Collaborated with legal counsel to successfully defend against litigation related to disputed liability claims.
- Conducted site visits for thorough assessments of damage in order to make accurate determinations on claim payouts.
- Handle complex property commercial claims for Water, Roof, Sump Pump, Fire and Theft. ·
- Assisted clients in understanding their policy benefits while navigating them through the complexities of liability insurance processes.
- In conjunction with Risk Management General Counsel supervised litigated claims.
- Effectively managed time-sensitive tasks under pressure without compromising the quality of work or customer service.
- Examined reports, accounts, and evidence to determine integrity and accuracy of information.
- Participated in audits of closed cases as part of ongoing quality assurance initiatives within the organization.
- Negotiated claim settlements with claimants and attorneys to resolve claims efficiently and fairly.
- Expedited claim settlements by effectively negotiating with claimants, attorneys, and other stakeholders.
- Developed in-depth understanding of insurance policies and procedures to give accurate recommendations to suit clients' needs.
- Analyzed and addressed escalated claims to resolve issues quickly.
- Researched and analyzed complex claims to determine next steps and possible outcomes.
- Managed multimillion dollar settlements in conjunction with Risk Management partners and Defense Counsel.
- Monitored and managed claim expenses to control costs and maximize profitability.
- Collaborated with internal departments and external vendors to achieve fast resolution of claims.
Litigation Specialist
Tracker Claims/SAG Claims
02.2023 - 10.2023
- Monitor the performance of a team of eight automobile claim representatives, using the tools and techniques available, and implement plans to improve performance timely and effectively.
- Coordinated expert witnesses for depositions and trial testimony, ensuring their availability when needed.
- Conducted thorough investigations of claims, gathering critical evidence to support case resolution.
- Streamlined litigation processes for improved efficiency and cost effectiveness.
- Collaborated with legal teams to develop winning strategies for clients in various industries.
- Litigated Commercial GL, Property, Bodily Injury, Product, Premises L.
- Analyzed legal issues and provided well-reasoned recommendations to attorneys on case strategy and tactics.
- Assisted attorneys in trial preparation, drafting pleadings, motions, and discovery documents.
- Negotiated settlements in mediation and arbitration settings, resulting in reduced litigation costs for clients.
- Identified potential risks or weaknesses in cases early on allowing proactive strategizing towards optimal resolution.
- Reduced case backlog by efficiently prioritizing and managing high-volume caseloads.
- Achieved favorable outcomes in complex cases through meticulous research and analysis.
- Developed strong working relationships with defense counsel for effective communication and negotiation throughout the litigation process.
- Handled high-stakes negotiations with defense counsel resulting in favorable outcomes without going to trial.
- Reviewed litigation docket and calendars on attorneys, noting deadlines for responsive pleadings, motions and other important deadlines.
- Review and handled NOI/CRN Clams to prepare response to be answered in timely manner.
- Negotiate settlement with PA/Attorneys
- Review and handle complex claims for product liability, slip and falls, dram shop, asbestos, premise liability, bodily injury.
- Responsible for negotiation and recovery efforts of third-party claims
- Review and reconcile estimates.
- Review the claim notice, contracts state statutes and policies to verify the appropriate coverage, deductibles, and payees.
- Determine monetary compensation owed to litigants.
Litigation Specialist
FKS Claims Management Inc.
12.2020 - 02.2023
- Determine coverage.
- Supervise the investigation of automobile accidents over the telephone and on site to determine liability.
- Direct auto claims representatives to pay property damage claims once liability has been determined adverse.
- Reviewed interrogatories, requests for admissions, requests for production of documents and requests for examination or inspection.
- Worked closely with litigation attorneys to research, complete trial preparations, and create document drafts for court use.
- Managed uninsured/underinsured motorist property/injury claims.
- Ensured compliance with court deadlines by maintaining an organized calendar system for all active cases.
- Manage reported claims to special investigations and completed reports as to the outcome of these investigations.
- Handle litigation files for property suits involving all perils, monitored, and authorized defense handling to a conclusion.
- Manage GL claims including product liability, slip and falls, dram shop, asbestos, premise liability, bodily injury.
- Supervise litigated claims with support of company legal counsel.
- Streamlined litigation processes for improved efficiency and cost effectiveness.
- Negotiated settlements in mediation and arbitration settings, resulting in reduced litigation costs for clients.
- Provided technical expertise related various types loss scenarios encountered across multiple lines business such as property damage bodily injury claims arising from automobile accidents workers compensation cases involving workplace injuries illnesses product liability matters resulting consumer complaints against manufacturers retailers defective goods causing harm users exposed unsafe conditions due design flaws manufacturing defects insufficient warnings provided intended user groups potentially at risk experiencing negative consequences associated usage specific items subject review investigation purposes.
- Works collaboratively with company's nurse professionals to develop and execute return to work strategies
- Within granted authority, establishes appropriate reserves with documented rationale, maintains and adjusts reserves over the life of the claim to reflect changes in exposure.
- Ensures timely denial or payment of WC benefits in accordance with jurisdictional requirements.
- Maintains a working knowledge of each state's jurisdictional requirements and applicable case law for each state serviced
- Developed strong working relationships with defense counsel for effective communication and negotiation throughout the litigation process.
- Assists insurer's clients by suggesting panel provider information in accordance with applicable state statutes
- Authorizes treatment based on the practiced protocols established by statute or the Insurer's Managed Care department
- Determines coverage, compensability, potential for subrogation recovery, and second injury fund (when applicable)
Litigation Claims Specialist
Barrett Claims Management
02.2017 - 12.2020
- Handled litigation files for property suits involving all perils, monitored, and authorized defense handling to a conclusion.
- Partner with in-house counsel on legal cased to resolve suit pre-trial. Work with defense and outside counsel. Negotiate a settlement with outside counsel.
- Handled files with significant indemnity exposure.
- Demonstrated adaptability by successfully managing a diverse range of claim types, including property damage, bodily injury, liability disputes, and more.
- Conducted comprehensive claim investigations to gather evidence, interview witnesses, and obtain relevant documentation.
- Achieved favorable case outcomes by thoroughly investigating claims, identifying liability, and evaluating damages.
- Managed a high volume of cases while maintaining organization and prioritizing tasks according to deadlines.
- Managed a high volume of cases while maintaining organization and prioritizing tasks according to deadlines.
- Prepared summaries of damage, payments, and policy coverage.
- identified the issues involved, formulate an action plan, assess liability, evaluate the damages involved, and put a settlement number on the claim and explain why
- Develop strategies for claims resolution with file notes reflecting clarity, focus, control/management, and momentum.
- Manage and review defense costs and assist with enforcement of the litigation management program.
- Prepare detailed written reports on claims, including (but not limited to) status reports and authority requests.
- Communicate the statuses of claims and the current action plan to management.
- Attend court appearances, attend meetings with top-level management, prepare and present recommendations regarding claim dispositions, and provide factual information and technical assistance.
- Review claims for subrogation potential and manage accordingly.
- Process check requests for all settlements in a timely and accurate manner.
Claims Specialist
Crawford And Company
01.2018 - 06.2019
- Identified fraudulent claims through diligent investigation and collaboration with law enforcement agencies when necessary.
- Managed a high volume of claims effectively by prioritizing tasks and maintaining excellent organizational skills.
- Document all review and assignment activity in XactAnalysis and internal systems where required. Verify appropriate use of estimating software and pricing database
- Conducted thorough analysis of complex claims for accurate valuation of losses in order to settle claims fairly.
- Routinely interacted with primary and excess insurance carriers, and re-insurers on file meeting reporting thresholds
- Maintained accurate records by diligently updating claim files and ensuring all required documentation was submitted in a timely manner.
- Streamlined the claims process for clients with proactive case management, regular updates, and prompt resolution.
- Settled complex claims fairly by applying critical thinking, negotiation skills, and detailed knowledge of insurance policies.
- Advanced knowledge of the water restoration industry to allow for evaluating proper drying techniques, equipment usage, and demolition/salvage determination.
- Supervised outside vendors retained for investigations, cost containment, expert witnesses, and litigation management to ensure claims are being handled appropriately according to the applicable jurisdiction.
- Conducted full claim investigations and reported updates and legal actions.
- Completed detailed and quality internal reports
- Recommends and sets reserves to ensure the reserves represent the probable ultimate payout based on documented file developments.
- Demonstrated adaptability by successfully managing a diverse range of claim types, including property damage, bodily injury, liability disputes, and more.
- Conducted risk evaluations on claims settlement proposals to encourage sound decision-making regarding settlement offers.
- Drafted and reviewed legal documents utilizing knowledge of relevant clauses to minimize incurred liability.
- Collaborated with legal counsel to make organizational claims decisions aligning with governing laws.
- Negotiated with other involved parties to arrange settlements for maximum results.
Property File Reviewer/Auto-Bodily Injury Adjuster
S&S Claims
11.2017 - 01.2019
- Review final submissions from field staff to ensure compliance with client guidelines and industry standards.
- Reviewed and approved over 300 claims. Investigate and evaluate property claims for clients.
- Reviewed estimate with Xactimate and made appropriate revisions in Xactimate/Xactanalysis based on photos.
- Evaluate and investigate policy coverage, liability and damages in a timely manner.
- Establish initial reserves for all potential exposures and adjust as appropriate.
- Attend arbitration, mediations and other settlement conferences as needed.
- Handles special level commercial claims for high profile insureds.
- Establish and maintain appropriate diary of open claims following company guidelines.
- Determine an appropriate reasonable range of value to negotiate fairly with attorneys and unrepresented claimants.
File Reviewer / Construction Defect Adjuster
David Morse & Associates
04.2017 - 11.2018
- Investigate construction defect losses; identify coverage; evaluate liability and damages; and review and analyze construction contracts, documents and legal pleadings.
- Review final submissions from field staff to ensure compliance with client guidelines and industry standards .
- Provide timely, accurate, fair, and professional service to all clients and insured parties while maintaining a high level of production .
- Review photos of any issues both defect related and/maintenance related.
- Ensured appropriate investigation of the underlying facts and circumstances is carried out, proper experts are retained and utilized where necessary.
- Authenticate all relevant activity on assigned files and makes recommendation for additional activity as appropriate.
- Draft reservation of rights and disclaimer letters.
- Reach out to claimants, attorneys, insureds, witnesses, and others to investigate construction defect claims.
- Assign counsel and experts to case and arrange for site inspections.
- Handle negotiation and settlement of both non litigated and litigated claims.
- Explore risk transfer and salvage and subrogation potential on all claims.
- Issue check or denial and secure appropriate releases to close claim.
- Investigated and determined coverage, investigation, evaluation of liability, evaluation of damages, negotiations, and resolution of case.
- Required to periodically travel to attend meditations, trials and / or other related meetings.
- Effectively communicate exposures both internally and externally overall responsibility for formulating proper resolution strategy to ensure best total outcome.
- Evaluate coverage issues and risk transfer opportunities Ensuring appropriate investigation of the underlying facts and circumstances is carried out.
Claims Specialist
Crawford And Company
01.2015 - 12.2017
- Investigated and handled ownership of patents, patent infringement, ownership of copyrights, copyright infringement, counterfeiting, trademark infringement, false advertising, trade defamation, cyber-piracy (concerning, e.g., domain name registration), ownership of websites, misappropriation of trade secrets, theft of artwork, fraud in the inducement, breach of fiduciary obligations.
- Identified fraudulent claims through diligent investigation and collaboration with law enforcement agencies when necessary.
- Maintained accurate records by diligently updating claim files and ensuring all required documentation was submitted in a timely manner.
- Investigated and handled ownership of patents, patent infringement, ownership of copyrights, copyright infringement, counterfeiting, trademark infringement, false advertising, trade defamation, cyber-piracy (concerning, e.g., domain name registration), ownership of websites, misappropriation of trade secrets, theft of artwork, fraud in the inducement, breach of fiduciary obligations.
- Investigated and processed claims reports and supporting documentation.
- Handle Workers Compensation claims
- Establish contact with employer to review issues.
- Respond to inquiries from the employer, employee, doctors and attorneys.
- Establish and maintain appropriate reserves.
- Review legal correspondence and medical reports.
- Evaluate and approve medical procedures and treatment.
- Administer benefits and ensure appropriateness of all payments.
- Investigate coverage, liability and monetary value of claim.
- Review medical and legal bills for appropriateness.
- Discuss appropriateness of medical treatment with medical case manager
- Determine compensability.
- Monitor and assist litigation.
- Negotiate settlement of claim, liens, rehabilitation plans, etc.
Claims Specialist
Crawford And Company
01.2017 - 04.2017
- Handles complex losses locally unassisted up to designated authority; assists on larger losses, including handling accounting-based losses (business interruption)
- Provide first and third-party property and injury adjusting services for commercial property, liability, auto, trucking, rental car, school districts, state transportation systems, airport shuttles, limousines, taxis, standard and non-standard personal auto, homeowner, umbrella, general liability, business interruption, construction defect, garage keepers liability, including litigation, arbitration and mediation.
- Attend mediations and settlement conferences as necessary.
- Handled Litigation and complex claim experience.
- Handled complex losses locally unassisted up to designated authority; assists on larger losses, including handling accounting-based losses (business interruption and stock)
- Examined claim form and other records to determine insurance coverage.
• Interviews, telephones, or corresponds with claimant and witnesses regarding claim.
• Informed injured workers of all treatment options.
• Coordinated claims case management with physicians and other health care professionals.
• Identified cases in need of medical management.
• Identified cases requiring workplace surveillance.
• Evaluated injured employees' compliance with prescribed physical therapy regimens.
Total Loss Adjuster
The Best IRS
12.2016 - 01.2017
- Collaborated with other adjusters to review complex cases and develop fair settlement offer
- Coordinated with legal counsel on litigated cases, ensuring all necessary documentation was prepared and submitted in a timely manner.
- Negotiated settlements with claimants, achieving mutually beneficial outcomes for all parties involved.
- Assisted in training new adjusters on company procedures and best practices for handling total loss claims effectively.
- Enhanced customer satisfaction by promptly and accurately assessing total loss claims.
- Supported colleagues during periods of high claim volume by assuming additional caseloads when needed.
- Achieved faster settlement agreements through effective negotiation tactics and clear communication skills.
- Consistently met or exceeded performance metrics related to claim cycle times and customer satisfaction ratings.
- Conducted thorough investigations to determine accurate claim payouts, resulting in fair resolutions for clients.
- Utilized advanced software programs to efficiently manage claim files and track progress toward resolution.
- Investigated potential fraud cases, protecting company assets from false or exaggerated claims.
- Streamlined the total loss claims process by implementing efficient procedures and best practices.
- Negotiated claim settlements when needed.
- Approved payment of claims within certain monetary limit.
- Negotiated with claimants to settle claims.
- Examined photographs and surveillance and any other documents relating to claims.
- Evaluated and investigated auto claims i and decided whether insurer should pay claim.
- Issued payouts to claimants.
- Documented all findings in concise reports.
- Carried and managed consistently heavy project workload through exemplary organizational, time management and collaboration talents.
- Coordinated with local body shops to assign repair jobs and obtained rental vehicles for customers for duration of restoration process.
- Assessed complex claims and accurately determined value of damages.
- Successfully negotiated settlements with claimants and insurers.
- Identified suspicious claims, escalating issues to supervisor for further investigation and analysis.
- Reviewed police reports, photographs and other documentation to gain complete understanding of accident.
- Created detailed assessments of damages to property and vehicles.
- Handling of vehicle disputes by research and appraisals .
- Coordinating rental with rental vendors and customers or determining loss of use .
- Reviewing estimates with customers and coordinating re - inspection if needed.
- Mitigating storage charges by coordinating salvage pick up .
- Handle subrogation from other carriers .
- Collaborated with other adjusters to review complex cases and develop fair settlement offers.
File Examiner
One Call Claims
10.2016 - 11.2016
- Ensured compliance with relevant laws, policies, and procedures throughout the examination process.
- Provided clear explanations of decisions made during examinations, enhancing transparency between applicants and organization.
- Served as a subject matter expert on specific claims and guiding colleagues in their evaluations when needed.
- Managed high volume caseloads, prioritizing tasks to meet strict deadlines while maintaining attention to detail.
- Conducted comprehensive reviews of complex claims, ensuring all necessary documentation was obtained before rendering a decision.
- Keep the customer informed about the claim status with clear, timely, and accurate written/oral communication.
- Discussed and explained coverage's, deductible, and claims process to named insured.
- Analyze and draft coverage letters and communicate coverage positions.
- Direct and monitor assignments to experts and independent field adjusters.
- Evaluate estimates for damages to determine the extent of exposure to the insured and company.
Claims Specialist
Catastrophe & National Claims
01.2016 - 10.2016
- Handled high-pressure situations with professionalism and composure, consistently achieving positive outcomes for both clients and the organization.
- Identified fraudulent claims through diligent investigation and collaboration with law enforcement agencies when necessary.
- Delivered comprehensive training sessions for new hires on claims handling procedures, policy interpretation basics, negotiation techniques, and other core competencies related to the role of a Claims Specialist.
- Maintained accurate file notes by diligently updating claim files and ensuring all required documentation was submitted in a timely manner.
- Demonstrated adaptability by successfully managing a diverse range of claim types, including property damage, bodily injury, liability disputes, and more.
- Managed a high volume of claims effectively by prioritizing tasks and maintaining excellent organizational skills.
- Reduced claim processing errors by conducting thorough investigations and accurately interpreting policy details.
- Developed strong working relationships with external partners such as adjusters, legal counsel, and medical professionals to facilitate efficient claim resolution processes.
- Collaborated closely with underwriting teams to ensure appropriate risk assessment measures were applied during policy issuance.
- Settled complex claims fairly by applying critical thinking, negotiation skills, and detailed knowledge of insurance policies.
- Provided exceptional customer service during stressful situations by offering empathy and support while resolving issues efficiently.
- Escalated files with significant indemnity exposure to supervisor for further investigation.
- Reviewed new files to determine current status of injury claim and to develop plan of action.
- Conducted full claim investigations and reported updates and legal actions.
- Understood requirements for disputes, gathered evidence to support claims and prepared customer cases to handle appeals.
- Responded to inquiries by answering questions, providing information and directing customers to appropriate resources.
- Drafted and reviewed legal documents utilizing knowledge of relevant clauses to minimize incurred liability.
- Drafted ROR and coverage denial letters.
- Negotiated with other involved parties to arrange settlements for maximum results.
Claims Specialist
Bintech
11.2015 - 01.2016
- Handled high-pressure situations with professionalism and composure, consistently achieving positive outcomes for both clients and the organization.
- Managed a high volume of claims effectively by prioritizing tasks and maintaining excellent organizational skills.
- Responsible for resolving disputed liability claims under limited supervision.
- Adhere to standard claim processes.
- Review medical records and bills to make a bodily injury evaluation, validate accuracy of treatment and negotiate bodily injury settlement with attorney or directly with injured party.
- Complete bodily injury evaluation including causation, diagnosis treatment, and general damages.
- Evaluate claim and case reserves, including periodically updating to ensure that the respective reserve properly reflects the potential exposure.
- Investigate liability, coverage, and bodily injury claims and determine outcome
Wardlaw Claims Services
Wardlaw Claims Services
08.2014 - 11.2015
- Optimized resource allocation through effective scheduling, prioritization of tasks, and delegation of responsibilities among team members.
- Assisted in training new employees on company policies, procedures, and best practices to improve overall efficiency.
- Contributed to the development of standard operating procedures that streamlined workflows across multiple departments.
- Increased team productivity with effective communication and collaboration strategies.
- Supported continuous improvement initiatives by participating in internal meetings aimed at identifying areas for training and development.
- Provide support, guidance, leadership, and motivation to promote maximum performance.
- Consult and meet with client management team on training.
- Ensure a high level of technical claim file quality from team members.
- Responsible for preparing and reviewing weekly timesheets for IA's and trainers.
- Responsible for day-to-day monitoring of attendance of IA's and reviewing for time off.
Senior Claims Associate
State Farm Insurance Company
03.2013 - 08.2014
- Managed high-priority claims in a time-sensitive manner, resulting in expedited resolution and satisfied clients.
- Conducted detailed investigations into potential subrogation opportunities, recovering funds owed to the company from at-fault parties.
- Negotiated fair settlements with legal counsel or other representatives on behalf of the company during dispute resolutions.
- Handled escalated customer concerns professionally while finding mutually beneficial solutions for both parties involved.
- Trained new Claims Associates on company policies and procedures, contributing to their rapid integration into the team.
- Examined reports, accounts, and evidence to determine integrity and accuracy of information.
- Interviewed policyholders to verify information and obtain additional details.
- Worked productively in fast-moving work environment to process large volumes of claims.
- Investigated accidents or incidents to determine cause and extent of damages.
- Negotiated claim settlements with claimants and attorneys to resolve claims efficiently and fairly.
- Monitored and managed claim expenses to control costs and maximize profitability.
- Researched and analyzed complex claims to determine next steps and possible outcomes.
- Determine coverage and identify coverage issues related to various claims, applying a thorough insurance policies and relevant coverage and loss types.
- Review claims and claim status with clients and brokers via phone and/or face-to-face interactions as necessary to facilitate the prompt, accurate resolution of claims filed.
Property Claims Specialist
Pilot Catastrophe Services
11.2012 - 02.2013
- Served as a liaison between clients and insurance carriers, facilitating clear communication and timely resolution of all claim-related issues.
- Leveraged strong analytical skills to evaluate complex property damage scenarios, determining optimal solutions for all parties involved.
- Worked closely with legal teams to resolve disputes related to property claims, avoiding costly litigation whenever possible.
- Provided expert consultation to policyholders regarding coverage options, guiding them towards informed decisions about their property protection needs.
- Evaluate claim and case reserves, including periodically updating reserves, to ensure that the respective reserve properly reflects potential exposure.
- Handle large caseloads, particularly following catastrophic events.
- Reviewed and examined files for property claims using Xactimate and approved payments for flood claims.
- Assigned and followed up with field adjusters and other experts for work product necessary to conclude claims.
- Negotiated settlements with clients for fair resolution of property claims, maintaining positive relationships.
- Mentored junior staff members on best practices in property claims management, fostering professional growth within the team environment.
- Followed up on potentially fraudulent claims initiated by claims representatives.
Senior Claims Specialist
Progressive Insurance Company
05.1999 - 10.2012
- Reviewed policy documents thoroughly before initiating coverage assessments so as not only identify gaps but also accurately interpret terms conditions applicable each situation faced when handling specific incidents reported by insured.
- Maintained compliance with regulatory requirements through diligent documentation of all claim activities.
- Enhanced team productivity by providing ongoing training to junior claims specialists on best practices and industry trends.
- Negotiated favorable claim settlements by utilizing strong communication and persuasion skills.
- Managed a caseload of complex claims, ensuring timely settlements and maintaining client satisfaction.
- Developed strong relationships with external partners such as healthcare providers, attorneys, and law enforcement agencies to facilitate effective claim handling processes.
- Boosted customer satisfaction ratings by providing prompt responses to inquiries and resolving issues in a timely manner.
- Assisted claimants throughout entire submission process, guiding them regarding proper documentation requirements needed substantiate requests while also clarifying expectations concerning how long investigations might take before final decisions made about whether approve deny payouts proposed based findings obtained during case evaluations conducted teams assigned specialists like myself.
- Conducted full claim investigations and reported updates and legal actions.
- Reviewed new files to determine current status of injury claim and to develop plan of action.
- Negotiated with other involved parties to arrange settlements for maximum results.
- Understood requirements for disputes, gathered evidence to support claims and prepared customer cases to handle appeals.
- Conducted risk evaluations on claims settlement proposals to encourage sound decision-making regarding settlement offers.
- Drafted and reviewed legal documents utilizing knowledge of relevant clauses to minimize incurred liability.
- Reviewed insurance and claims documents to verify required information and secure any missing data for settlements.
- Collaborated with legal counsel to make organizational claims decisions aligning with governing laws.
Education
Master of Science - Marketing
Georgia State University
Atlanta, GA12.2011
MBA - Business Administration
University of Phoenix
Tempe, AZ10.2008
Bachelor of Science - Business Administration
University of South Carolina - Columbia
Columbia, SC07.1989
Skills
- Claims file management processes
- Litigation resolution
- Claims Evaluation
- Knowledge of Insurance policies and endorsements for policy investigation
- Reserve Adjustment/Reserve Recommendations
- Drafting coverage denial letters/ROR letters
Certification
NFIP Certified – 70004856
TWIA Certified | Tower Hill Certified | FEMA Badge
Adjuster Licenses
AL,AK, AZ, AR, CA, CT, DE, FL, GA, HI, ID, IN, KY, LA,ME,MI.MN,MS,MT,NV,NY,NC,OK,OR,RI,SC,TX,UT,WV
Timeline
Commercial Claims Specialist
Custard Insurance Adjusters Inc.
10.2023 - 01.2024
Litigation Specialist
Tracker Claims/SAG Claims
02.2023 - 10.2023
Litigation Specialist
FKS Claims Management Inc.
12.2020 - 02.2023
Claims Specialist
Crawford And Company
01.2018 - 06.2019
Property File Reviewer/Auto-Bodily Injury Adjuster
S&S Claims
11.2017 - 01.2019
File Reviewer / Construction Defect Adjuster
David Morse & Associates
04.2017 - 11.2018
Litigation Claims Specialist
Barrett Claims Management
02.2017 - 12.2020
Claims Specialist
Crawford And Company
01.2017 - 04.2017
Total Loss Adjuster
The Best IRS
12.2016 - 01.2017
File Examiner
One Call Claims
10.2016 - 11.2016
Claims Specialist
Catastrophe & National Claims
01.2016 - 10.2016
Claims Specialist
Bintech
11.2015 - 01.2016
Claims Specialist
Crawford And Company
01.2015 - 12.2017
Wardlaw Claims Services
Wardlaw Claims Services
08.2014 - 11.2015
Senior Claims Associate
State Farm Insurance Company
03.2013 - 08.2014
Property Claims Specialist
Pilot Catastrophe Services
11.2012 - 02.2013
Senior General Liability Claims Representative
Gallagher Bassett Services, Inc
10.2003 - 01.2024
Senior Claims Specialist
Progressive Insurance Company
05.1999 - 10.2012
Master of Science - Marketing
Georgia State University
MBA - Business Administration
University of Phoenix
Bachelor of Science - Business Administration
University of South Carolina - Columbia
NFIP Certified – 70004856
TWIA Certified | Tower Hill Certified | FEMA Badge
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