Dora Brown
Ruskin
Summary
Experienced insurance professional with several-year career assessing properties, determining liabilities and negotiating settlements. Detail-oriented, observant and knowledgeable with excellent interpersonal and documentation skills. Efficiently handle high case volumes with accuracy and care.
Overview
12
12
years of professional experience
Work History
Workers' Compensation Claims Adjuster
Employers
07.2023 - 04.2026
- Reviewed workers' compensation claims for accuracy and completeness.
- Coordinated communication between claimants, employers, and medical providers.
- Investigated claims to determine validity and gather necessary documentation.
- Evaluated medical reports to assess injury-related conditions and treatment plans.
- Managed case files and maintained detailed records of claims progress.
- Ensured compliance with state regulations and company policies throughout processes.
- Maintained accurate records of all claim activities including correspondence, reports, investigations, settlements.
- Reviewed medical records, interviewed employers and claimants, analyzed wage loss calculations, and reviewed evidence for accuracy.
- Monitored claim progress and issued appropriate notices to maintain continued progress on claim processing and eliminate liability to company.
Workers' Compensation Specialist
ALOIS Temp Agency (Sedgwick)
07.2023 - 12.2023
- Calling and confirming appointments via phone and email
- Assuring the WC, NF and Lien case is active for Medical Treatment
- Determined liability, compensability and benefits due on each claim.
- Monitored claim progress and issued appropriate notices to maintain continued progress on claim processing and eliminate liability to company.
- Investigate claims by interviewing claimant, employer, witnesses, and physicians.
- Determine compensability and total value of claim
- Maintain reserves
Claims Adjuster
Riley Adjustment Bureau
02.2021 - 07.2023
- Examined claims forms and other records to determine insurance coverage.
- Verified insurance claims and determined fair amount for settlement.
- Reviewed police reports, medical treatment records, and physical property damage to determine extent of liability.
- Conducted comprehensive interviews of witnesses and claimants to gather facts and information.
- Documented all investigation activity and presented reports to management.
- Evaluated insurance policies and analyzed damages to determine coverage.
- Negotiated with policyholders and claimants to reach mutually satisfactory resolutions.
- Maintained suspicious claims database and prepared reports for supervisors.
- Negotiated favorable settlements with claimants, attorneys, and other insurance carriers to minimize financial risk for the company.
- Conducted thorough investigations of complex insurance claims, gathering evidence and analyzing relevant documentation.
Auto Claims Adjuster
Progressive
07.2019 - 07.2021
- Enhanced customer satisfaction by efficiently managing auto claims and providing prompt resolutions.
- Ensured regulatory compliance in all aspects of the auto claims process by staying up-to-date on industry laws and regulations.
- Issued payouts to claimants.
- Managed a high volume caseload without sacrificing quality or timeliness in delivering resolutions to clients'' auto accident-related issues.
- Reviewed police reports, photographs and other documentation to gain complete understanding of accident.
- Successfully negotiated settlements with claimants and insurers.
Customer Service Representative
Progressive
07.2018 - 07.2019
- Review coverages on home and auto insurance policy
- Process payments
- Developed strong product knowledge to provide informed recommendations based on individual customer needs.
Workers' Compensation Case Manager
Aetna
05.2014 - 05.2018
- Reviewed new files to determine current status of injury claim and to develop plan of action.
- Reviewed police reports, medical treatment records, and physical property damage to determine extent of liability.
- Conducted comprehensive interviews of witnesses and claimants to gather facts and information.
- Identified suspicious losses and contacted manager for investigative assistance.
- Determine coverage, compensability, potential for subrogation recovery, Federal DBA/longshore, and second injury funds.
- Establishes reserves and authorizes payments within reserving authority limits.
Education
Bachelor of Business Administration
University of Phoenix
Certificate NPN# W650389 - All Lines Claims Adjuster Florida
Central Insurance School
High School Diploma -
Middleton High School
Tampa, FLSkills
- Decision Making
- Critical Thinking
- Settlement Negotiations
- Microsoft Office
- Xactimate
- Pyramid
- Juris
- Problem-Solving
- Multitasking
- Time Management
- Excellent Communication
- Organizational Skills
- Workers' compensation laws
- Automobile claims specialist
Timeline
Workers' Compensation Claims Adjuster
Employers
07.2023 - 04.2026
Workers' Compensation Specialist
ALOIS Temp Agency (Sedgwick)
07.2023 - 12.2023
Claims Adjuster
Riley Adjustment Bureau
02.2021 - 07.2023
Auto Claims Adjuster
Progressive
07.2019 - 07.2021
Customer Service Representative
Progressive
07.2018 - 07.2019
Workers' Compensation Case Manager
Aetna
05.2014 - 05.2018
Bachelor of Business Administration
University of Phoenix
Certificate NPN# W650389 - All Lines Claims Adjuster Florida
Central Insurance School
High School Diploma -
Middleton High School