
California Litigation and Complex Claims Examiner managing high-value injury claims from investigation through resolution. Balances liability evaluation, damages analysis, settlement negotiation, and litigation management to move complex casualty files toward efficient outcomes. Builds clear working relationships with insureds, attorneys, and opposing counsel while maintaining sound claims handling.
Examiner managing a high volume of litigated and complex claims with significant injury and high value. Significant experience negotiating claims with personal injury counsel and assessing risk to best protect the insured while maintaining regular communication with insureds, attorneys, adverse carriers, and company management to ensure seamless integration of company processes while maintaining Department of Insurance standards. Working closely with unrepresented claimants to ensure they feel comfortable throughout the claims process and ensure that they feel properly compensated without attorney involvement.
Managed a high volume of attorney-represented bodily injury claims while ensuring insureds are fully informed of the claims process. Communicated regularly with attorneys while attempting to proactively resolve claims to protect the interests of both the insured and the company. Implemented company changes and improved the ability to evaluate claims efficiently using knowledge developed from the industry.
Assisted with development of a new department by coaching team of claims adjusters handling complex coverage concerns during regular business hours. Managed a team with a mixture of new and inexperienced claims associates, with claims associates handling simple claims without complex coverage issues. Helped adjusters develop an understanding of insurance contracts and how to apply the contract language to complicated coverage issues. Led a team of adjusters through the insurance investigation process, utilizing numerous resources, including those typically less utilized. Completed regular audits for a team of adjusters to ensure they grasp the knowledge of fair claims in practices and department of insurance standards, while maintaining a customer service-oriented mindset.
Developed understanding of insurance contract as it applies to claims. Investigated complicated coverage issues while keeping regular communication with insureds, claimants, and adverse carriers. Identified issues meeting criteria for investigative involvement and worked closely with internal SIU to properly investigate fraud concerns, then communicate any relevant concerns to policy underwriting in order to assess proper risk. Point of contact for claim file management to ensure customer service standards met and department of insurance guidelines followed while implementing changes based on the development of the industry as a whole.