CLAUDIA BURKE- AIC
Neptune,USA
Summary
Responsible Medical Claims adjuster with strong attention to detail and juggles multiple tasks. Bilingual go-getter committed to handling claims expeditiously. Seeking to work for a fast-growing company that offers a promising career.
Detail-oriented and analytical claims adjuster with 6 years of experience in efficiently handling complex claims, ensuring timely and accurate resolution. Proven track record in assessing and investigation claims while maintaining excellent customer services standards.
Overview
6
6
years of professional experience
1
1
Certificate
Work History
PIP MEDICAL/ LIT CLAIMS ADJUSTER
Plymouth
05.2022 - Current
- Receiving assigned PIP medical claims, verifying coverage, and confirming eligibility
- Analyzing medical records to assess the nature and extend of injuries, treatment plan, and reasonable of billed charges.
- Conducted thorough investigations of complex insurance claims, gathering evidence and analyzing relevant documentation.
- Maintaining effective follow up system on pending files, prioritize and handle multiple tasks simultaneously, adjust to fluctuating workload, and advise injured parties as to status of claim
- Investigates and interpreting policy provisions and conditions to make coverage determination
- Strong understanding of tort law, insurance policy language, and legal precedents related to claims
- Negotiated favorable settlements with claimants, attorneys, and other insurance carriers to minimize financial risk for the company.
DAMAGE CLAIMS ADJUSTER
Plymouth
01.2019 - 05.2022
- Conduct thorough investigations by gathering information from various sources including police reports, medical records, witness statements, and claimant interviews to establish the facts of the accident and determine liability
- Regularly review customer policies and resolve coverage issues with speed accuracy
- Handle moderate- severe complexity auto claims- Glass, Theft, commercial with minimal supervision
- Conducting investigations to verify the legitimacy of the claim, including potential fraud detection
- Provided exceptional customer service during emotionally difficult situations for policyholders following accidents.
Education
B.A - Fashion Business Management
Fashion Institute of Technology
New York, NY05.2001
A.S - Fashion Design
Altos De Chavón
La Romana, Dominican Republic01.1997
Skills
- Problem solving
- Team oriented
- Work Organizing and Prioritizing
- Multitasking
- Decision Making
- Microsoft Office
- ImageRight
- Claims investigation
- Settlement negotiation
- Caseload management
Languages
Spanish
Full Professional
Timeline
PIP MEDICAL/ LIT CLAIMS ADJUSTER
Plymouth
05.2022 - Current
DAMAGE CLAIMS ADJUSTER
Plymouth
01.2019 - 05.2022
B.A - Fashion Business Management
Fashion Institute of Technology
A.S - Fashion Design
Altos De Chavón
Certification
- Associate in Claims, AIC
LICENSEs
Florida, Connecticut and New Hampshire
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