Detail-oriented casualty adjuster with 9 years of claims experience, driven to resolve claims fairly while representing interests of the company. Conducts thorough and informed investigations, precisely evaluates losses and negotiates settlements that satisfy all parties. Builds and maintains professional and productive relationships and works to understand potentially conflicting points of view.
Overview
12
12
years of professional experience
Work History
Bodily Injury Claims Specialist
Liberty Mutual
Chandler, AZ
01.2022 - Current
Investigated bodily injury claims and determined coverage eligibility.
Assessed medical records, witness statements, and police reports to evaluate liability.
Negotiated settlements with claimants and attorneys.
Reviewed insurance policies for applicable coverage limits and exclusions.
Prepared detailed documentation outlining claim decisions, actions taken, and rationale for settlement amounts.
Conducted research on legal precedents related to bodily injury claims handling.
Maintained accurate records of all claim files, including documents related to claim resolution activities.
Collaborated with outside vendors such as adjusters, investigators, and lawyers throughout the claims process.
Drafted correspondence between insurers and claimants about settlement offers or other matters related to the case.
Communicated with other departments to establish action plans and manage open claims to closure.
Oversaw regulatory and strategic initiatives to ensure accuracy of medical claims.
Checked documentation for appropriate coding, catching errors and making revisions.
Handled billing related activities focused on medical specialties.
Auto Claim Specialist
GEICO, Government Employees Insurance
Richardson, TX
04.2019 - 01.2022
Was promoted four times within three years.
Called insurance companies to ascertain pertinent information regarding policies and payment benefits for patients.
Verified policy holder data, including age, contact number and physical address.
Checked documentation for appropriate coding, catching errors and making revisions.
Instructed clients on amounts covered under policy plans in easy-to-understand terminology.
Trained newly hired top talent to fill key positions and maximize productivity.
Tested trainees on materials to determine levels of understanding and areas requiring further instruction.
Identified areas of concern uncovered during training sessions and suggested methods to reduce risk.
Reduced process gaps by training new hires on best practices and protocols.
Scripted, recorded and uploaded instructional videos for remote learning students.
Resolved customer issues efficiently to build loyalty.
Complied with confidentiality regulations in handling customer information.
Handled billing related activities focused on medical specialties.
Examined automobile policies with third-party liability, accident benefits and collision benefits.
Signed payment approvals accepted claims.
Analyzed medical bills, police reports and medical treatment records
Fostered relationships with product support staff, technical personnel, sales leaders, finance team and executives to transform and strengthen business processes.
Exceeded team goals and collaborated with staff to implement customer service initiatives.
Maintained up-to-date knowledge of store policies regarding payments, returns and exchanges in order to provide speedy and accurate service to each customer.
Capitalized on opportunities to enhance customer experiences and bring in repeat business.
Escalated customer satisfaction ratings by offering valuable insights to customers' needs and expectations.
Worked under strict deadlines and responded to service requests and emergency call-outs.
Documented patterns and queries that may indicate a larger problem with the product or service that needs to be resolved.
Auto Claims Adjuster
State Farm
Richardson, TX
02.2016 - 11.2017
Researched and verified insurance policy coverage.
Evaluated extent of damage and documented findings.
Negotiated settlements with customers and lien holders paid out total loss settlements and obtained necessary documents to process titles for branding.
Determined cause and extent of damages by investigating claims with underwriters and insurance agents in field.
Provide customer support to members, providers, billing departments, and other insurance agency's regarding claims, appeals, and eligibility.
Presented claims to insurance companies.
Maintain quality standards by reviewing claims while working off project list.
Coordinate benefits while applying applicable deductibles, co-insurance, and out of pocket costs.
Assisted attorneys in claimant defense if claim is contested.
Evaluated claims for possible fraud, contacting appropriate department for assistance and further investigation.
Provided policyholders with advice regarding vehicle repairs and body shop procedures to maximize customer satisfaction.
Supervisor
Starbucks
Rowlett, TX
05.2013 - 07.2016
Resolved customer complaints and submitted feedback to adjust policies that would meet changing needs.
Established and enforced clear goals to keep employees working collaboratively.
Coached and mentored 16 staff members through constructive feedback
Assisted in interviewing applicants, recommended individuals for hiring and evaluated staff performance.
Kept the store on-target to meet sales and profit objectives by minimizing waste and pursuing revenue opportunities.
Coached staff on strategies to enhance performance and improve customer relations.
Lead meetings in educating and expanding the staffs knowledge on Ecolab, OSHA, and state guidelines
Placed weekly orders for low inventory items always adhering to budget and consumer need
Greeted consumers and assisted in deescalting any misunderstanding that may have arouse
Office Manager
A&J Steel
Greenville, TX
11.2014 - 06.2015
Scheduled and Coordinated meetings, appointments, business retreats, and travel arrangements for the C-level executive's and their potential cliental
Trained and mentored new hired associates in company policies, daily task execution, and daily requirements.
Assisted with developing new filing practices to remain organized allowing us easy access to track all documents both physical copies and digital
Maintained discretion when dealing with company sensitive topics
Operated social media accounts on multiple platforms to grow exposure of the company and expand its reach
Reviewed bids and prepared Client reports for the executives.
Stayed current with new developments or changes with various carriers as well as new Federal/state laws. Reported such changes to the executives and legal team.
Served as an advocate to our clients and employees through positive built relationships
Maintained impeccable office organization to support efficiency, professionalism and performance objectives.
Managed office budget to handle inventory, postage and vendor services.