Carla King
Sanford
Summary
Service-oriented Claims Adjuster skilled at applying creative approaches to solving complex problems. Adept at developing profitable and quality-focused processes. Claims Adjuster with deep experience in confidential litigation claims. Superbly positioned to investigate, evaluate and settle lost time claims. Excellent abilities to decipher fraudulent activities, analyze data, confer with legal counsel and communicate with insured and brokers to gain details for processing claims. Detailed Adjuster with 5 years of experience in corporate insurance claims. Strong command of claimant information intake processes, records documentation and fraudulent investigation protocols.
Conducting Claim reviews.
Detail-oriented team player with strong organizational skills. Ability to handle multiple projects simultaneously with a high degree of accuracy.
Overview
18
18
years of professional experience
1
1
Certification
Work History
Claims Adjuster
Zurich Insurance Company
03.2019 - 02.2024
- Conducted thorough investigations of complex insurance claims, gathering evidence and analyzing relevant documentation.
- Negotiated settlement agreements to resolve disputes.
- Maintained contact with claimants and assigned nurse to determine treatment status of the compensable body part(s).
- Handled Florida no coverage files.
- Analyzed information gathered by investigation and reported findings and recommendations.
- Maintained compliance with state regulatory requirements through meticulous documentation and adherence to company policies.
- Delivered exceptional customer service to the insured's and claimants.
- Issued lost wage benefits timely required beyond the 7day waiting period in the state of Florida.
Auto/Liability Adjuster
Allstate Insurance
09.2018 - 12.2018
- Conducted auto investigations with policy holder to determine liability.
- Confirm policyholder deductible.
- Scheduled and set up repair shop appointments for damages.
- Followed up with insured individuals regarding premium and deductibles payments.
- Reviewed police reports, medical treatment records, and physical property damage to determine extent of liability.
- Maintained contact with claimants and attorneys to determine treatment status.
- Improved customer satisfaction by promptly addressing and resolving auto liability claims.
- Investigated losses and identified coverage issues.
Medical Only Adjuster
AmTrust
07.2017 - 09.2018
- 3 point contact performed with employer, claimant, and medical provider.
- Confirmed no lost time beyond the 7 day period in the state of Florida, to be deemed a Medical Only Claim.
- Coordinate and authorize medical treatment for compensable injury.
- bring claim to resolution, and close file.
Medical Only Adjuster
North American Risk Services
11.2016 - 07.2017
- 3 point contact performed with employer, claimant, and medical provider.
- Confirmed no lost time beyond waiting period in the state of Florida, to be deemed a Medical Only Claim.
- handled FL, NC, SC, TN, GA, CA, and AZ states, as medical only.
- Coordinate and authorize medical treatment for compensable injury.
- bring claim to resolution, and close file.
Medical Only Adjuster
Gallagher Bassett Services Inc.
06.2006 - 10.2016
- 3 point contact performed with employer, claimant, and medical provider.
- Confirmed no lost time beyond the period in assigned license states to be deemed a medical only claim.
- Handled FL, GA, SC, and NC. medical only claims.
- Coordinate and authorize medical treatment for compensable injury.
- bring claim to resolution, and close file.
Education
High School Diploma -
Robinson High School
Tampa, FL06.1985
Skills
- Holds and maintains an active Florida 520 Adjuster License
- Best Practices Implementation
- Decision-Making
- Negotiation and mediation
- Critical Thinking
- Customer service and support
- Claims Investigation
- Advanced oral and written communication skills
- Payment Processing
- Claims Evaluation
- Report and Records Review
- Claims adjustment
Certification
- Licensed - Work Compensation Adjuster since 2006.
Timeline
Claims Adjuster
Zurich Insurance Company
03.2019 - 02.2024
Auto/Liability Adjuster
Allstate Insurance
09.2018 - 12.2018
Medical Only Adjuster
AmTrust
07.2017 - 09.2018
Medical Only Adjuster
North American Risk Services
11.2016 - 07.2017
Medical Only Adjuster
Gallagher Bassett Services Inc.
06.2006 - 10.2016
High School Diploma -
Robinson High School
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