Dana McCall Hargrave
Summary
Highly organized and trained Claims Specialist with an excellent history of successful claims management and loss minimization. Creative and independent problem-solver who also coordinates well with management and other company employees. Flexible scheduling availability to cover weekends and emergency situations as required.
Overview
40
40
years of professional experience
Work History
Claims Examiner
Claims Consultant
Austin, TX
08.2017 - Current
- Managed a caseload of 3360 claims each quarter.
- Reviewed data to verify the validity of claims.
- Risk Assessment and Mitigation
- Assist in Mediation
- Damage Assessment Evaluation of proper repairs
- Documentation Policy Records Management
- Liaison between claims adjustment team and senior management regarding all claims related issues
Claims Examiner
Texas Fair Plan
Austin , TX
08.2017 - 10.2017
- Identified and acted on damage mitigation opportunities.
- Validated all claims completely and accurately.
- Utilized appropriate claims tools to assess damages fully and accurately.
- Reviewed determined and released reimbursements to various customers.
- Performed all work in accordance with customer and company standards.
Claims Adjuster/ Claims Reviewer
N&C Claims Service, Inc.
Sarasota, FLA
01.2000 - 12.2010
- Reduced loss ratios through fair and prompt processing of claims.
- Obtained relevant evidence and information regarding suspicious claims.
- Conducted interviews, gathered detailed information and completed field investigations.
- Closed all claim investigations with full and appropriate documentation
- .Arranged and facilitated settlement meetings with customers and senior company representatives.
- Monitored lawsuits and open claims to ensure timely information transmission.
Workman's Compensation Litigation Specialist
Summit Risk Services
Houston , TX
02.1990 - 09.1995
- Managed all litigation and City of Houston counsel services for the city workers compensation.
- Investigated and documented facts regarding contract coverage disputes.
- Drafted coverage denials and reservations of rights correspondence detailing status.
- Maintained favorable contract liability, police / fireman fatality accidents and occupational accident / workers compensation loss ratios.
- Reviewed court and legal documentation with claims, law and fraud functions.
- Attended deposition of company representative regarding a claim against the City of Houston
- Working knowledge Texas workers compensation, l insurance coverage, industry specific injuries, underwriting and claims practices.
Claims Adjuster (P&C, Workers Comp, Long Shore & Habor)
Hammerman & Gainer Adjusters
Houston, TX
05.1986 - 08.1990
- Worked with customers to arrange vehicle inspections.
- Responsible for determining level of loss for each case and deciding on compensation for client.
- Assisted in gathering data and information for cases that wound up being taken to court for various reason
- Investigated and processed claims reports and supporting documentation.
- Identified and removed obstacles to ensure highest quality claims outcomes.
- Analyzed merits and financial impacts of injury circumstances.
Education
Bachelor of Science - Computer Science
Texas A&M University
1986
Skills
- Extensive experience in claims management, adjusting and reviewing
- Exceptional knowledge of insurance contracts coverage claims management programs and all related policy,l and legal terminology
- Superior ability to interpret and review account statements and histories
- Strong grasp of a variety of claim processing rules and guidelines
- Excellent skills in analyzing legal documents and policies
- Outstanding proficiency with Microsoft Office applications such as Word Access and Excel
- High problem-solving and organizational skills
- Proven ability to self-motivate and work independently
- Solid written and oral communication skills
Affiliations
- Houston Livestock Show and Rodeo volunteer
- Montgomery County Fair Association volunteer
Timeline
Claims Examiner
Claims Consultant
08.2017 - Current
Claims Examiner
Texas Fair Plan
08.2017 - 10.2017
Claims Adjuster/ Claims Reviewer
N&C Claims Service, Inc.
01.2000 - 12.2010
Workman's Compensation Litigation Specialist
Summit Risk Services
02.1990 - 09.1995
Claims Adjuster (P&C, Workers Comp, Long Shore & Habor)
Hammerman & Gainer Adjusters
05.1986 - 08.1990
Bachelor of Science - Computer Science
Texas A&M University