David Grothaus
Chandler,AZ
Summary
Results-driven Casualty Claims Manager with expertise in claims analysis, staff management, and procedure implementation. Proven track record of enhancing operational efficiency and reducing turnaround times through effective team leadership.
Overview
28
28
years of professional experience
1
1
Certification
Work History
Casualty Claims Manager
American Family Insurance
Madison, WI
02.2012 - 04.2026
- Led claims processing team to enhance operational efficiency and reduce turnaround times.
- Analyzed claims data trends to identify areas for process improvements and risk mitigation strategies.
- Mentored aspiring managers on best practices in claims assessment and dispute resolution techniques.
- Established performance metrics for the claims department, driving accountability and continuous improvement initiatives.
- Coordinated audits of claim files to ensure adherence to company policies and industry standards.
- Collaborated with other departments to improve overall organizational effectiveness in addressing client needs.
- Streamlined communication between adjusters and clients, expediting claim resolution times.
- Implemented quality assurance measures, monitoring staff performance and providing constructive feedback for continuous improvement efforts.
- Managed a team of adjusters, providing coaching and performance feedback for improved productivity.
- Implemented fraud detection measures, minimizing financial losses due to fraudulent activities.
- Reduced claim disputes by enforcing strict adherence to policy terms and conditions.
- Determined proper course of action for claims processing.
- Oversaw regular audits of claim files ensuring accuracy in reserve amounts and adherence to established guidelines.
- Maintained compliance with industry regulations during all stages of the claims process.
Claims Examiner
American Family Insurance
Madison, WI
09.1998 - 02.2012
- Reviewed and processed insurance claims for accuracy and compliance with policy guidelines.
- Analyzed claim documentation to determine valid coverage and appropriate payment amounts.
- Collaborated with internal teams to resolve complex claims issues efficiently.
- Conducted thorough investigations on disputed claims, ensuring fair assessments.
- Mentored junior examiners on best practices in claims evaluation and resolution processes.
- Implemented process improvements that enhanced claim processing efficiency and reduced turnaround time.
- Utilized analytical skills to evaluate medical bills for accuracy and appropriateness of charges before approving payments as part of the claims process.
- Participated in cross-functional team meetings to address organizational challenges related to claims management and develop solutions collaboratively.
- Examined photographs and statements.
- Negotiated settlements with claimants'' attorneys when needed, achieving favorable outcomes for both parties while minimizing costs.
- Conducted thorough investigations of complex claims, gathering relevant documentation and interviewing witnesses when necessary.
- Identified opportunities for subrogation recovery through careful analysis of third-party liability cases, facilitating successful recoveries from at-fault parties or their insurers.
- Interviewed claimants and witnesses to gather factual information.
- Reviewed police reports, medical treatment records, and physical property damage to determine extent of liability.
- Delivered exceptional customer service to policyholders by communicating important information and patiently listening to issues.
- Visited customer locations to evaluate damage and provided cost estimates for remediation.
Education
Bachelor of Science - Criminal Justice
Northern Arizona University
Flagstaff, AZ05-1990
Skills
- Claims analysis
- Policy interpretation
- Claims investigation and research
- Procedure implementation
- Staff training
- Continuous improvement
- Staff management
Certification
Arizona Insurance license
Califormina Insurance license
Timeline
Casualty Claims Manager
American Family Insurance
02.2012 - 04.2026
Claims Examiner
American Family Insurance
09.1998 - 02.2012
Bachelor of Science - Criminal Justice
Northern Arizona University