Calisha Marie Baker
Powder Springs,GA
Summary
8 years of claims handling experience. Proven ability to work independently & multi-task effectively. Strong history in handling Flood, Property, Auto claims & Bodily injury/General liability, Commercial & Business Interruption. History of settling claims in a timely fashion. Adept at working under pressure & time restraints. Maintained spreadsheets to ensure claim compliance deadlines met. Negotiation to resolve claim amicably, Agreed settlement with executed release. Proficient in Xactimate, Symbility, XactAnalysis, NextGen & ECS, Flood Connect, Claims Xchange, Guidewire & Claims Center Outstanding training, leadership, and communication skills. Litigation experience working with property damage QA/QC claim handling & claim review. Effectively worked with client & defense counsel handling litigated claims to complete timely & effective investigations & settlements.
Overview
9
9
years of professional experience
Work History
Liability Adjuster
Allstate Insurance Co
Powder Springs, GA
01.2024 - Current
- Investigated liability claims and determined coverage based on policy language and applicable law.
- Identified potential responsible parties, conducted interviews, gathered evidence, and evaluated damages.
- Negotiated settlements with claimants, attorneys and other representatives.
- Drafted letters of denial or explanation of coverage for auto liability claims.
- Reviewed police reports, witness statements, accident reconstruction reports and other documents related to an incident.
- Prepared detailed summaries of each claim file including all pertinent information regarding coverage issues, liability determinations and damages calculations.
- Monitored payment activity to ensure timely resolution of claims within established guidelines.
- Provided customer service support to insureds by answering questions about their claim status or providing additional information as needed.
- Maintained contact with clients throughout the life cycle of a claim in order to keep them informed of its progress.
- Participated in periodic audits that ensured compliance with departmental standards and procedures.
- Adhered strictly to all state regulations concerning timely filing requirements for auto insurance claims.
- Continuously updated knowledge base through research, webinars, seminars or other training opportunities.
- Provided quality customer service to assigned, insured and claimants throughout claims process to deliver timely service to customers.
- Interviewed and spoke with claimants, witnesses, police officers, doctors and other parties to determine claim settlement or denial.
Litigation Claims Examiner
Sedgwick- Liberty Mutual
, GA
01.2023 - 07.2023
- Paid and processed claims within designated authority level.
- Handled and processed variety of claims, including Property and Auto
- Reviewed, evaluated and adjusted claims to promote fair and prompt settlement.
- Double-checked and reviewed documentation for denied and accepted insurance claims.
- Completed required investigations on referred files within established timeframes.
- Evaluated evidence with ultimate goal of creating positive outcomes for client's claims.
- Entered claim transactions, payments, reserves and other documentation.
- Researched and followed up on denied insurance claims.
- Verified and analyzed claims settlement data to ensure validity.
- Obtained necessary information to complete proper evaluation of injury claims.
- Communicated with personnel and legal counsel on claims involving litigation.
- Investigated questionable claims to determine payment authorization.
- Evaluated acceptability of claims from third-parties and gathered comprehensive information.
- Supervised independent adjusters to promote adherence to guidelines.
- Consulted accountants, engineers, lawyers and physicians when needed.
Independent Claims Adjuster
CRU-Citizens Insurance
, FL
07.2022 - 01.2023
- Hurricane Ian
- Property Claims
- LAE invoice payments
- MObile Home total loss
- PA/attorney acknowlegement
- Alacrity-State Farm 04/2022
- Auto Claims - Total Loss
- Negotiated and settled claims according to information presented through reports, research and data verification.
- Investigated claims, conducted field audits, determined losses and reported findings.
- Completed required investigations on referred files within established timeframes.
- Analyzed and audited open claims to calculate additional payments owed.
- Investigated potentially fraudulent claims with focus on thoroughness, quality and cost control.
- Drafted statement of loss to summarize damages, payments and underlying policy coverage.
Desk Adjuster/File Examiner/Mediation
PLS-UPC Insurance
01.2018 - 01.2019
- Pre litigation/Public adjusters/complexity/Large loss
- Reviewed files and endorsements to insure coverage and eligibility met to approve payment
- Electronically entered payments on submitted documents and photos to be reviewed for claim settlement review
- Communicated effectively with attorneys to resolve the claim
- Worked with contractors and General contractors with supplements due to missed components
- Consulted with Building consultants for comparative estimates on large loss and complexity claims
- Consulted with engineers to determine the causation of the damages
- Negotiated with attorneys and public adjuster to settle the claim with an executed signed release
- Work closely with mediators to reach an agreed settlement
- Resolved claims in pre litigation
- Alternative dispute resolution
- Responded to complaints file to the state department of insurance
Desk Adjuster/File Examiner/Condo Commercial
DMA Claims Services, Florida
01.2017 - 01.2018
- Reviewed files and endorsements to ensure coverage and eligibility met to approve payment
- Electronically entered payments on submitted documents and photos to be reviewed for claim settlement review
- Provided courteous customer care
- Entered information on submitted claims to ensure the timely progression of claim determination and eligibility
- Ensured compliance standards were met for all claims
- Submitted file for payment after all documentation submitted and attached to file
- Reviewed Master policy & By Laws
- Communicated effectively with the HOA
- Processed Business Interruption claims
- Worked with Forensic Accountants
- Reviewed Schedule C, bank records, P&L statements and sales records
- Calculated projected gross sales for the loss year
- Calculated projected gross expense for the loss year
- Calculated projected net profit For the loss year
- IEM QA/QC/Desk Examiner –Restore Louisiana Project 2017
- Reviewed files and endorsements to insure coverage and eligibility met to approve payment
- Electronically entered payments on submitted documents and photos to be reviewed for claim settlement review
- Provided courteous customer care
- Entered information on submitted claims to ensure the timely progression of claim determination and eligibility
- Ensured compliance standards were met for all claims
- Submitted file for payment after all documentation submitted and attached to file.
Loss/Earthquake Desk Examiner
Pilot Catastrophe Large
Bakersfield, California
01.2015 - 01.2017
- Identifies when to retain, manage, and direct other vendors necessary to resolve claims, including contents specialists, accountants, contractors, appraisers, salvage specialists, restoration specialists, cause and origin specialists, and coverage counsel
- Daily review of workflow and claim system reminders with follow up and significant progress toward completion of any task set as a reminder or received in workflow within 72 hours
- Review of new claims assignments within 24 hours of assignment/Completion of the Plan of Action
- Contact with the insured/claimant within 24 hours of assignment
- Interview or obtain recorded statements from the claimant, the Insured and any witnesses
- Run ISO Claimsearch
- Respond to Reservation of Rights letters from Excess Carrier if necessary
- Negotiate with Attorneys
- Generate release Pilot Catastrophe Pilot Catastrophe / Catastrophe Management
Desk Adjuster/Agent Advocate/Compliance Assistant/Customer Service Rep/Claims Processor
, AL
01.2015 - 01.2016
- Contact claimants to schedule appointments to inspect for catastrophe related losses
- Electronically entered findings and submitted documents and photos to be reviewed for processing
- Provided courteous customer care
- Entered information on submitted claims to ensure the timely progression of claim determination and eligibility
- Ensured compliance standards were met for all claims
- Liaison for agents, adjusters and insureds, providing information to ensure timely claims process
- Contacted adjusters to advise them of outstanding invoices needing submittal
- Assisted outside adjusters complete daily billing of outstanding invoices to be approved for payroll
- Generated reports to track problematic insurance claims
- Entered information on submitted claims to ensure the timely progression of claim determination and eligibility
- Processed Flood, Wind & Hail related homeowners claims
- Ensured compliance standards were met for NFIP claims
- Negotiated settlements with PA & Attorney to bring claim to mutually agreeable resolution
- Provided necessary documentation to the legal department for claims that could not be resolved pre-trial.
Education
BA - Business Administration
Jackson State University
01.2009
Advanced with Honors Diploma -
C.F. Vigor High School
01.2003
Certifications State farm – Auto & Fire NFIP-Flood Certified -
Skills
- Liability, Property & casualty, Customer service, Claims handling, Property
- Claims, Auto claims, Investigating, Litigating, Estimating, Business claims, Fire
- Insurance, Hail and crop damage, Water & flood claims, Working with industry
- Experts, Computer skills, Policy knowledge
- Claims File Management Processes
- Team Leadership
- Claims Processing
- Team Training
- MS Office
- Settlement Negotiations
- Verbal and Written Communication
- Payment Processing
- Property Claims
- Claims Evaluation
- Policy Investigations
- Complex Problem Solving
- Coverage Determination
- Litigation Management
- Property Adjusting
- Settlement Negotiation
- Customer Service and Support
- Claims Investigation
- Policy investigations
- Legal Compliance
- Independent Judgment
- Policy Interpretation
- Liability Analysis
Timeline
Liability Adjuster
Allstate Insurance Co
01.2024 - Current
Litigation Claims Examiner
Sedgwick- Liberty Mutual
01.2023 - 07.2023
Independent Claims Adjuster
CRU-Citizens Insurance
07.2022 - 01.2023
Desk Adjuster/File Examiner/Mediation
PLS-UPC Insurance
01.2018 - 01.2019
Desk Adjuster/File Examiner/Condo Commercial
DMA Claims Services, Florida
01.2017 - 01.2018
Loss/Earthquake Desk Examiner
Pilot Catastrophe Large
01.2015 - 01.2017
Desk Adjuster/Agent Advocate/Compliance Assistant/Customer Service Rep/Claims Processor
01.2015 - 01.2016
BA - Business Administration
Jackson State University
Advanced with Honors Diploma -
C.F. Vigor High School
Certifications State farm – Auto & Fire NFIP-Flood Certified -
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