Job Search Status
Open to workDesired start date: Open to discussion
Open To Work
Danny Raines
Claims Management
Hallsville,TX
Work Preference
Summary
Commercial Claims Manager with 42 years of experience in managing a wide range of insurance claims. Proven expertise in residential and commercial insurance policies, negotiation, and client relationship management. Successfully implemented claim handling procedures that enhanced efficiency and customer satisfaction. Strong background in construction knowledge and a commitment to ongoing professional development.
Overview
42
42
years of professional experience
3
3
Certification
Work History
Commercial Claims Manager
Pilot Catastrophe Services
Mobile
08.1992 - Current
- Managed the commercial claims process from intake to resolution.
- Reviewed policy documents for compliance and coverage accuracy.
- Collaborated with legal teams to assess claim validity and risk exposure.
- Trained staff on claims handling procedures and best practices.
- Utilized claims management software for tracking and reporting purposes.
- Communicated effectively with clients regarding claim status and requirements.
- Developed strategies for improving claim processing efficiency and effectiveness.
- Resolved disputes through negotiation while maintaining client relationships.
- Ensured all customer interactions were handled professionally while maintaining highest standards of service excellence.
- Collaborated closely with internal stakeholders such as underwriters, actuaries, as well as external vendors and suppliers involved in the claim resolution process.
- Participated in training sessions organized by the organization regarding new regulatory requirements affecting commercial insurance products and services.
- Identified areas for improvement within the department's process flows by performing root cause analysis.
- Conducted regular audits of claim files to identify trends or patterns that may indicate potential fraud or abuse.
- Managed assigned workloads efficiently by prioritizing tasks based on their urgency and importance levels.
- Developed, implemented, monitored and maintained claims procedures for the department to ensure efficient workflow.
- Identified areas of improvement within existing processes and implemented corrective action plans accordingly.
- Reviewed and processed all claims for commercial policies to ensure accuracy, timeliness and compliance with applicable laws.
- Maintained detailed records of all claims activities including payment histories, status updates.
- Assisted in developing strategies for reducing overall costs associated with processing claims.
- Provided technical guidance and support to other team members regarding best practices in handling commercial claims.
- Coordinated with legal counsels in resolving disputes related to claim payments or denials.
- Performed periodic reviews of existing contracts and agreements between the company and its clients related to claims management services.
- Resolved complex customer inquiries and complaints in a timely manner by providing accurate information and solutions.
- Negotiated settlements with customers on behalf of the company while ensuring compliance with relevant regulations.
- Investigated high-value claims to ensure appropriate coverage was being provided according to policy terms and conditions.
- Trained new team members on policies and procedures for claims handling.
- Managed team members effectively to meet high production standards with accurate results.
- Collaborated with quality team regarding quality assurance reviews.
- Oversaw onboarding processes for new team members, delivering training on claims handling.
- Motivated team members to maintain targeted turnaround time to obtain processing goals.
- Conducted meetings to discuss issues and find pertinent solutions to problems.
- Submitted clean claims to reduce denial rates, following payer reimbursement policies and procedures.
- Oversaw the handling of catastrophic claims, mobilizing resources and coordinating with emergency services for rapid response.
- Established strong relationships with external partners, including adjusters and contractors, to streamline claims resolution.
- Directed the application of reserves on claims, ensuring accurate financial reporting and compliance with regulatory requirements.
- Engaged in continuous professional development, staying abreast of industry trends, legal developments, and best practices in claims management.
Multi-Line Claims Adjuster
Hanover Insurance Group Inc.
Shreveport
01.1990 - 08.1992
- Investigated multi-line claims to assess coverage and liability effectively.
- Reviewed claim documentation for accuracy and completeness, ensuring integrity in processing.
- Communicated with policyholders to gather essential information for claims evaluation.
- Collaborated with legal teams on complex claims and disputes to ensure resolution.
- Facilitated negotiations between claimants and insurance providers for settlement agreements.
- Maintained accurate records of claim activities, including investigations and settlements.
- Advised management on potential bad faith exposures from claim handling practices.
- Conducted field investigations and interviews to resolve intricate claims issues.
Catastrophe Claims Adjuster
Pilot Catastrophe Services
Mobile
10.1983 - 01.1990
- Evaluated claims for property damage from natural disasters and severe weather events.
- Collaborated with policyholders to gather necessary documentation for claim processing.
- Assessed damages and estimated repair costs using industry-standard software tools.
- Communicated with contractors and specialists to verify repair estimates and timelines.
- Reviewed policy coverage details to determine liability and settlement amounts.
- Maintained accurate records of claims progress in the company's management system.
- Conducted field inspections to assess damage conditions and validate claim submissions.
- Worked directly with clients affected by catastrophes in order to provide support and assistance during a difficult time.
- Provided technical guidance to adjusters regarding complex claims issues.
- Assessed the extent of damages caused by a catastrophe and estimated repair costs.
Education
Graduate Certificate - Property And Liability Management
Vale Technical College
Arlington, Texas06-1990
Graduate Certificate - Auto Damage Appraiser
Insurance Technical Training Institute
Dallas, TX05-1989
Graduate Certificate - Residential Property Damage Estimating
Insurance Technical Training Institute
Dallas, TX10-1983
Graduate Certificate - Computer Applications Development
Draughon Business College
Shreveport, LA09-1982
High School Diploma -
Haughton High School
Haughton, LA11-1981
Skills
- Insurance claims management
- Claims management expertise
- Communication management professional
- Planning and organization
- Time management
- Team building leadership
- Team management
- Customer relationship management
- Problem solving
- Effective communication
- Policy compliance
- Legal collaboration
- Negotiation strategies
- Attention to detail
- Conflict resolution
- Claims processing
- Claims analysis
- Policy interpretation
- Multitasking Abilities
- Self motivation
Certification
Property and Casualty license in 22 states
References
References available upon request.
Timeline
Commercial Claims Manager
Pilot Catastrophe Services
08.1992 - Current
Multi-Line Claims Adjuster
Hanover Insurance Group Inc.
01.1990 - 08.1992
Catastrophe Claims Adjuster
Pilot Catastrophe Services
10.1983 - 01.1990
Graduate Certificate - Property And Liability Management
Vale Technical College
Graduate Certificate - Auto Damage Appraiser
Insurance Technical Training Institute
Graduate Certificate - Residential Property Damage Estimating
Insurance Technical Training Institute
Graduate Certificate - Computer Applications Development
Draughon Business College
High School Diploma -
Haughton High School