Summary
Overview
Work History
Education
Skills
Accomplishments
Timeline
Generic

DELSENA WHITTY

Decatur,GA

Summary

Extensive background in claims management services, negotiation, and business management. Outstanding presentation and leadership skills; able to manage team in absence of Management. Expertise in organization and analysis; adept at multi-tasking. Licensed to adjust claims in several states including; MI, FL, GA, for all lines.

Overview

22
22
years of professional experience

Work History

Claims Litigation Management Specialist

AAA MICHIGAN
Southfield, MI
11.2011 - 01.2016
  • Upon receipt of a new assignment I review the pleadings and/or any amendments then refer the case out to a referral attorney
  • I confirm with the referral attorney that answer and affirmative defenses have been filed
  • Once this has been completed I monitor the court website for the scheduling orders, and any other court orders
  • I respond on the company's behalf to interrogatories to question related directly to the company
  • Attended deposition if necessary on a case by cases basis; review the deposition transcripts of each case to determine if they will make good witnesses or not
  • Discuss the plaintiff medical with referral attorney to determine expose and if the injuries meet thresholds
  • Instruct referral attorney to file summary disposition motions on cases that are non-threshold
  • Instruct the referral attorney on filling motions, surveillance, and investigation
  • Attend case evaluation/mediation/facilitation/settlement conferences and trials
  • Notify the company when theirs circumstances other than the facts of the case that present exposure, i.e
  • Aggravated liability, bad venue, etc
  • Implement training for new litigation specialist.

Bodily Injury Adjuster

Casualty
Southfield, MI
07.2007 - Current
  • I manage, handle and process approximately 200 complex multi-state bodily injury, uninsured and underinsured motorist, and property damage claims which entail inspecting motor vehicles involved in motor vehicle accidents, and Inspecting damage to property as a result of motor vehicle accident, included but not limited too: trailers, homes, commercial property, etc
  • Conduct thorough investigations gathering information to determine exposure and liability to proportionate appropriate negligence
  • Analyze accident and/or incident to determine if the alleged injury could be caused by the accident and/or incident
  • Review medical records to ensure the treatment received was appropriate for the injury Monitor reserve to assure the reserve is appropriate for the exposure Ensure customer service for our insured and potential insured Assist colleagues with Facts training I review est
  • For damages to property as a result to ensure the estimate is within the company guidelines and rates to ensure the estimate is in compliance with state statutes, regulatory compliance guidelines and automobile tort laws
  • Negotiate and resolve claims using fair claims settlement practices
  • Due to the complexity of some claims may also use legal dispute resolution options
  • Identify and address subrogation by placing parties on notice of right to recovery in a timely manner handling recoveries to completion
  • Mange and resolve claims promptly in compliance with the time compliance regulatory guidelines required by each state.

Senior Claims Examiner

Sedgwick CMS
Troy, MI
01.2001 - 07.2007
  • Manage, analyze and process over 250 complex or technically difficult claims including but not limited too;
  • Commercial General Liability, Commercial Auto BI & PD, PIP, Commercial Property Damage, and Specialty claims by investigating and gathering information to determine the exposure on the claim, then managing claim through well-developed action plans to an appropriate and timely resolution
  • Assess strengths and weaknesses of lawsuits and develop plans of action for defending and disposing of same
  • Maintain communication with defense counsel
  • Attend depositions, court appearances and mediations
  • Analyze cost effectiveness and make recommendations based on the investigation's strengths
  • Continue investigations including interviews, recorded statements, securing public records and obtaining documents on point for moderate to complex claims
  • Confirm coverage and recognize coverage issues
  • Negotiate and communicate effectively with medical providers, attorneys, customers and vendors
  • Provide lawsuit management
  • Handled complex injury claims from first notice of exposure through litigation to resolution maintaining cost control of medical management and diagnostic procedures, maintaining communication with medical providers and vendor to assure vital medical treatment was provided to achieve recovery in a timely manner
  • Handled complex product defect claims to resolution by investigating contract agreements between involved parties to confirm indemnity and hold harmless agreements thus filing subrogation and tenders to appropriate parties
  • Identified the proximate cause of the loss claims to determine if there was a product defect, or misuse, and/or mishandling of the product
  • Train and supervise 14 to 18 colleagues, including Senior, Intermediate, and Junior Claims Examiners in absence of the Team Manager
  • Responsible for emergency procedures for my team in case of emergency situation
  • Manage claim recoveries, including subrogation, second Injury Fund recovery, and Social Security offsets
  • Carry out risk management and develop execution strategies, document all business processes
  • Created and established Quality System to evaluate and acquire new clients, provide improvement feedback to clients, and expand business with clients
  • Developed and implemented time management procedures for colleagues who needed assistance with organizational skills and good file management
  • Formulated and implemented claims handling procedures to meet client expectations
  • Successfully managed large project meeting deadlines
  • Managed bankruptcy files; displayed expertise in bankruptcy laws and file management, bringing bankruptcy file to a resolution in a cost effective manner.

Education

Associate of Business Administration - Management

Wayne County Community College
01.2006

Management Phlebotomy License -

Crocket Vocational Training Center
01.1996

Skills

  • Relationship Building
  • Property Owner Representation
  • Claims Evaluation
  • Claims Processing
  • Property Damage Assessment
  • Critical Thinking
  • Regulatory Compliance
  • Legal Documentation and Reporting
  • Complex Problem Solving
  • Coverage Assessment
  • Title Examination
  • Settlement Negotiations
  • Conflict Resolution
  • File and Record Management
  • Decision Making
  • Fraudulent Claims Investigation
  • Information Confidentiality
  • Public Speaking
  • Report and Records Review
  • Litigation Management
  • Sourcing and Compiling Information
  • Computer Skills
  • Expense Control
  • Coaching and Mentoring
  • Staff Management
  • Reserves Adjustment
  • MS Office
  • Team Training
  • Risk Assessment Software
  • Calm Under Pressure
  • CGI-AMS BureauLink Enterprise
  • Payment Processing
  • Team Leadership
  • Reserves Recommendations
  • Accident Investigations
  • Settlement Determinations
  • Documentation Review
  • Coverage Assessments
  • Client Interviewing
  • Claim Form Analysis
  • Active Listening
  • Complex Mathematics
  • Evidence Collection and Preservation
  • Insurance Fraud
  • Liability Determination
  • Verbal and Written Communication
  • Case Presentation
  • Trend Evaluations
  • Fraud Patterns
  • Training & Development
  • Reliable & Trustworthy
  • First Aid/CPR
  • People Skills
  • Team Management
  • Flexible Schedule

Accomplishments

  • I have recognized a few times in our internal news for playing a key roles in uncovering claims rings
  • I've received awards for perfect attendance for the past 5 years.

Timeline

Claims Litigation Management Specialist

AAA MICHIGAN
11.2011 - 01.2016

Bodily Injury Adjuster

Casualty
07.2007 - Current

Senior Claims Examiner

Sedgwick CMS
01.2001 - 07.2007

Associate of Business Administration - Management

Wayne County Community College

Management Phlebotomy License -

Crocket Vocational Training Center

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DELSENA WHITTY