Investigated insurance claims to determine liability and damages.
Analyzed policy provisions, legal documents and medical records.
Negotiated settlements with claimants, attorneys and other parties regarding serious injury cases
Resolved claims for insureds by providing relevant policy details and excellent customer service.
Decreased loss ratios through fair and timely claim processing.
Negotiated total loss settlements by reasonably applying company estimates to benefit both client and company needs.
Drafted correspondence related to claim investigations and settlements.
Assessed potential losses for insureds in accordance with applicable laws and regulations.
Evaluated subrogation opportunities to identify recoverable funds.
Maintained detailed records of all claim activities in a timely manner.
Provided coverage opinions based on analysis of facts, law, policy language and endorsements.
Researched relevant case law to support coverage decisions.
Reviewed property damage estimates for accuracy and completeness.
Conducted witness interviews to assist claim information gathering process.
Injury Adjuster - Bodily Injury Claims
08.2013 - 08.2016
Receive first notice of losses and transfer claims involving 3rd party injuries
Investigate the facts of the accident and arrange vehicle inspections for both the insured's and claimants
Review vehicle damages, police reports and recorded statements from all parties involved in order to reach a sound liability decision
Evaluate bodily injury demands, which include office records and radiology reports, as well as research ISO hits in order to reach a fair settlement for injured claimants when our member is at fault for the accident
Upon the event a lawsuit is filed against USAA and/or the member I will prepare the claim for our litigation department
While handling all these aspects of this position I also listen to our members in order to assist them with any other needs they may need outside of the claims experience.
Injury Adjuster - First Party Claims
08.2009 - 08.2013
Receive claims involving injuries to our members and/or the passengers in their vehicles
Investigate and adjust moderate to complex medical bills and pay what is reasonable and necessary for the treatment rendered
Analyze information obtained to establish the validity of the claim being reported as well as research the policy to ensure we are paying what is owed
Liaison between the injured party, attorney and medical providers throughout the claims process
Obtain recorded statements from drivers, pedestrians and other injured parties when necessary
Assisted in the overflow of New York AIS in order to pay bills timely and provide an exceptional member experience
Selected to be a part of the work at home team where I remained for 2 years of my time in this position
While handling all these aspects of this position I also listen to our members in order to assist them with any other needs they may need outside of the claims experience
I was selected to be a mentor for Auto Adjuster II's
Part of the mentor/mentee program between First and Third Party Injury
Non Injury Adjuster
12.2007 - 08.2009
I received first notice of losses and transfer files regarding complex claims with no injured parties
Obtain statements from drivers, pedestrians, passengers, and witnesses as well as review police reports in order to make an educated liability decision
Arranged vehicle inspections for both claimant and insured vehicles
Communicate policy language, coverage and procedures to insured's and or attorneys
While handling all these aspects of this position I also listen to our members in order to assist them with any other needs they may need outside of the claims experience
Immediate Response Unit
02.2007 - 12.2007
Receive initial new losses and handled single vehicle accidents, animal collisions and partial theft claims
Assigned more complex claims to the proper area Arrange vehicle repairs and rental for the time those vehicles are in the shop
I was selected to assist others in order to maintain their diary load
While handling all these aspects of this position I also listen to our members in order to assist them with any other needs they may need outside of the claims experience.
Department Manager
Wal-Mart
San Antonio, TX
02.2005 - 05.1999
Lead and manage a team of 15 employees in the Department, ensuring that all tasks are completed efficiently and on time.
Coached and trained new staff members, providing guidance on department policies and procedures.
Ensured compliance with all safety regulations in the workplace.
Conducted regular performance reviews to monitor progress of individual employees.
Analyzed weekly reports to identify areas for improvement in operations, budgeting, and staffing levels.
Resolved customer complaints promptly and professionally in order to maintain good relationships with clients.
Created monthly schedules for staff members to ensure adequate coverage during peak hours.
Maintained up-to-date records of inventory levels for efficient ordering and stocking purposes.
Organized quarterly meetings with senior management to review departmental goals and objectives.
Customer Service Manager
Developed and implemented strategies for providing excellent customer service experience.
Reviewed customer feedback and complaints to identify areas of improvement in customer service processes.
Monitored staff performance to ensure adherence to customer service standards of over 100 employees
Conducted regular training sessions for staff on new products, services, and customer service techniques.
Managed the development of a comprehensive knowledge base used by team members when responding to customers' queries.
Collaborated with senior management team members in designing strategies that would improve overall quality of services offered by the organization.
Layaway Associate
Assisted customers with selecting merchandise and determining payment plans for layaway purchases.
Provided information on store policies, procedures and services to customers.
Maintained a clean and orderly work area throughout the store.
Organized stockroom shelves and racks according to company standards.
Completed paperwork accurately and in a timely manner for all transactions.
Balanced cash drawer daily at the end of shift.
Answered incoming calls from customers regarding product availability, pricing, orders and other inquiries.
Verified that all items purchased were accounted for before completing sales transaction.
Resolved customer complaints promptly in order to maintain positive customer relations.
Tracked progress of open layaway accounts on a weekly basis.
Monitored expiration dates of layaways and contacted customers as needed.
Cashier
Greeted customers and answered any questions they had about the store's products and services.
Verified that customers were of legal age to purchase alcohol or tobacco products.
Operated cash register efficiently and accurately, processed payments by cash, check, credit card, gift card or automatic debit.
Counted money in cash drawer at the beginning of shift to ensure that amounts were correct and have sufficient change.
Issued receipts, refunds, credits or change due to customers.
Maintained cleanliness of checkout area including countertops, registers, windowsills and floors.
Reconciled transactions at end of shift using appropriate forms and reports to verify accuracy of transactions.
Education
High School Diploma -
Waverly City Schools
Waverly, Oh
01.2000
Bachelor Degree - Criminal Justice
University of Phoenix
Certified Fraud Examiners certification -
Certified in Medical Billing and Coding -
Performance Training Institute
Skills
Vendor Relationship Management
Process improvement strategies
Team leadership abilities
Project management experience
Quality assurance standards
Performance metrics evaluation
Certification
Gold Senior Claims Law Associate (SCLA) May 3, 2010
Workers Compensation Claim Law Associate (WCLA) April 2, 2010
Property Claim Law Associate (PCLA) February 17, 2010
Automobile Claim Law Associate (ACLA) July 9, 2009
Casualty Claim Law Associate (CCLA) May 4, 2009
Fraud Claim Law Associate (FCLA) March 29, 2009
Legal Principles Claim Specialist (LPCS) March 3, 2009
Licensed Texas Insurance Claims Adjuster 2007
Accomplishments
Current POC for USAA Serves for Non-Injury Claims
APD Hands on Training Coordinator for the MST
Developed Exposure Distribution strategy to reassign claims for the MST
Developed Huddle Board Strategy to implement within the MST
Mentee with SIU: consists of observing the role of special investigators and case managers. I have also participated in ride a longs with field agents.
Mentee with Property and ATF: observe the various types of property and theft claims, gain knowledge on what to look for in these areas that may be suspicious
Affiliations
Selected for Claims Underwriting Development Knowledge Program
Member of the Political Action Committee
Selected for the Cup team which assists on handling workload for adjusters out on PTO.
Business Support Analys Senior at United Services Automobile Association, USAABusiness Support Analys Senior at United Services Automobile Association, USAA
Insurance Sales Professional at United Services Automobile Association, USAAInsurance Sales Professional at United Services Automobile Association, USAA