Candace Wilson

Claims Management & Case Oversight

• Independently managed a full caseload of personal auto bodily injury claims, including attorney-represented files, from first notice of loss through final settlement, resolution, or escalation to litigation.
• Ensured all claims were handled in compliance with policy provisions, state regulations, and company best practices.
• Retained ownership of claims even after suit was filed, re-evaluating files to pursue settlement opportunities before litigation.

Investigation & Liability Assessment

• Conducted comprehensive investigations, analyzing recorded statements, police reports, medical records, billing documentation, and other supporting evidence.
• Applied comparative negligence principles and policy interpretation to establish liability decisions, assess exposure, and set accurate reserves.
• Reviewed medical specials, general damages, and treatment patterns to determine fair and defensible settlement values.

Attorney-Represented Claims & Litigation Support

• Coordinated with plaintiff counsel, responded to letters of representation, and negotiated pre-litigation settlements.
• Prepared files for potential litigation, maintaining proactive communication strategies to control claim costs and mitigate litigation risk.
• Worked closely with attorneys and private investigators to gather evidence, witness statements, and documentation for trial preparation.

Negotiation & Settlement

• Negotiated settlements with claimants, insureds, attorneys, and medical providers within designated authority limits.
• Achieved timely, fair, and cost-effective resolutions while protecting company interests.

Documentation & Compliance

• Maintained accurate, detailed, and compliant claim records in automated claims management systems.
• Consistently met productivity, quality, and timeliness standards in a fast-paced, metrics-driven environment.

Customer Service & Communication

• Delivered professional, empathetic service to policyholders, claimants, and stakeholders.
• Clearly communicated complex information and handled sensitive situations with tact and efficiency.

• Analyzed information gathered by investigations to report findings and recommendations.
• Reviewed police reports, medical treatment records, and physical property damage to determine extent of liability.
• Reviewed questionable claims by conducting agent and claimant interviews to correct omissions and errors.
• Examined claims forms and other records to determine insurance coverage.
• Conducted day-to-day administrative tasks to maintain information files and process paperwork.
• Delivered exceptional customer service to policyholders by communicating important information and patiently listening to issues.
• Worked with private investigators and attorneys on preparation of evidence, witness statements, and other documentation in preparation for trial.
• Negotiated with policyholders and claimants to reach mutually satisfactory resolutions.
• Handled Bodily Injury settlements for attorney repped clients on a contracted basis while being a stay at home mother.

• Upon receipt of a new claim, Investigating the claim to determine if the policyholder has valid coverage at the time of the incident. Resolved any applicable coverage conditions with the coverage gate or RLA/Management if necessary.
• Accurately documented, interviewed and took recorded statements from all parties involved in the auto-accident including key witnesses and passengers claiming to have bodily injury.
• Reviewed claim for liability decision or denied based on the investigation and evidence presented.
• Provided detailed explanations of insurance coverage ,policy limitations and Bodily injury coverage as well as the process to move claim toward closure.
• Managed complex cases involving personal injury, property damage and bodily injury.
• Resolved customer inquiries, complaints, and disputes in a timely manner while giving superior customer service.
• Reviewed and interpreting medical bills for injured parties with new and/or preexisting conditions. Determine how preexisting conditions could impact the present claim. Discussed possible additional reserves with management if injury was determined to be severe enough.
• Referencing applicable case law/statutes, rules of the road and complexity of injury to determine if claim should be escalated to a higher level of claims processing.
• Settled bodily injury claims with non-represented parties by reviewing medical bills and reports.
• Settled bodily injury claims with represented parties by reviewing time sensitive demands sent by their attorney. Made offers, sent offer letters and took recorded or written releases to close/settle the claim.
• Settled claims within policy limits with authorized amounts by management.
• Participated in and coached in the training programs designed to assist new employees on how to quickly and efficiently handle a claim.
• Attended training and educational seminars to enhance knowledge and credentials.
• Reduced loss ratios through fair and prompt processing of claims.
• Adhered strictly to applicable laws and regulations governing insurance industry operations. Maintained confidentiality of sensitive customer information at all times.