Edward Barnes
East Point,Ga.
Summary
Highly motivated, results-driven expert and Claims Adjuster specializing in ML, LLM, personal property and casualty, liability and litigation loss and damages. Negotiates peaceful resolutions of all claims with an emphasis on fairness and thoroughness. Professional with extensive experience meeting critical goals in a fast-paced, high-growth, dynamic environment. Committed to serving clients while maintaining high ethical standards and working cross- functionally to accomplish objectives. Excellent organizational skills and ability to work in a fast-paced environment. Serves effectively as a member of a team. Strong conflict resolution and communication skills, both oral and written. Articulate communicator able to convey complex information in simplistic terms. Strong interpersonal skills, with a proven ability to establish rapport with challenging clients, patients, and other personnel.
Overview
13
13
years of professional experience
1
1
Certification
Work History
Claims Examiner – Flood Claims Hurricanes Beryl, Helene and Milton
Torrent – WYO/NFIP
10.2024 - 01.2026
- Review estimates for accuracy and revisions per FEMA and NFIP guidelines
- Review of preliminary reports for advance payments
- Reviewed RAPS for additional supplementary payments
- Staged payments for review
- Reviewing Claims
- Determining Coverage
- Evaluating Documentation
- Identifying Potential Fraud
- Making Decisions
- Negotiating Settlements
- Ensuring Compliance
- Working with Public Adjusters and Attorneys
WCCS – Deployed – Field Adjuster
State Farm Insurance
02.2024 - 10.2024
- Deployed to catastrophe areas for inspections
- Scoping of insured risks
- Write estimates per State Far Guidelines
- Review and write denials per State Far Guidelines
- Sketching of interior damage
- Issuing of payments
- Setting up ALE and issuing of ALE payments
- Calling and settling of claims from FNOL to closure
Complex Claims Adjuster
American Family Insurance
Oklahoma
08.2023 - 02.2024
- Analyzes and manages complex or technically difficult claims by investigating and gathering information to determine the exposure on the claim; manages claims through well-developed action plans to an appropriate and timely resolution.
- Calculates and assigns timely and appropriate reserves to claims; manages reserve adequacy throughout the life of the claim.
- Assesses liability and resolves claims within evaluation.
- Daily Residential, represented and non-represented claims
Liability Claims Adjuster
Commonwealth Insurance
Oklahoma
03.2023 - 05.2023
- Reviewed police reports, medical treatment records, medical bills, or physical property damage to determine the extent of liability.
- Conducted investigations into automobile accidents to determine liability and payment.
- Assesses liability and resolves claims within evaluation.
- Coverage determination, liability investigation and analysis including comparative negligence.
Claims Adjuster
UPC Insurance
11.2022 - 02.2023
- Collaborated Estimates in Xactimate, Set reserves.
- Negotiated payoffs on claims with PA’s and Attorney’s.
- Prepared Xactimate estimates, Statement of Losses, and Letters for all payments.
- Makes recommendations for settlements or denial of claims.
- Approval/Denial of claims and Supplements.
- Calculates and assigns timely and appropriate reserves to claims; manages reserve adequacy throughout the life of the claim.
- Analyzes and manages complex or technically difficult claims by investigating and gathering information to determine the exposure on the claim; manages claims through well-developed action plans to an appropriate and timely resolution.
- Assesses liability and resolves claims within evaluation.
Residential Auto Claims
The Littleton Group – Progressive
Nashville, TN
07.2021 - 09.2022
- Conducted investigations into automobile accidents to determine liability and payment.
- Analyzed medical records to evaluate injury claims for settlement.
- Submitted reports to management for settlement authority or significant events such as lawsuits, trials, excess liability exposure and/or fatalities.
- Explained to customers the claims process, their policy and compensation.
- Maintained an inventory of over 200 claim files.
- Processed salvage vehicles; identified and handled subrogation (collection) opportunities.
- Examined claims forms and other records to determine insurance coverage.
- Investigated and assessed damage to property and create or review property damage estimates.
- Reviewed police reports, medical treatment records, medical bills, or physical property damage to determine the extent of liability.
- Analyzed information gathered by investigation, and report findings and recommendations.
- Interviewed or corresponded with agents and claimants to correct errors or omissions and to investigate questionable claims.
- Prepared report of findings of investigation.
- Examined titles to property to determine validity and act as company agent in transactions with property owners.
- Investigates claims for merit and legitimacy by gathering documentation from all affected parties identifies and verifies damage to person or property either through statements or on-site investigations or meetings with clients.
- Establishes appropriate pricing of claims based on research and analysis.
- Notifies clients of results of investigations. Discusses lines of authority for specific claims resolution.
- Makes recommendations for settlements or denial of claims.
- Processes denials.
- Manages complex or multi-jurisdictional claims.
- Negotiates claims with claimants and or claimants’ legal counsel.
- Obtains required releases for finalization of claims.
- Properly reserves funds.
- Adjusts client claim reserves appropriately.
Virtual Residential Claims Adjuster
Crawford – Allstate
Allen, TX
05.2021 - 07.2021
- Took calls Virtually from Field Appraisers, documented the losses and wrote claims in X1
- Prepared Xactimate estimates, Statement of Losses, and Letters for all payments
- Contacted the homeowners and issued payment based on the estimate
- Negotiated with contractors to resolve supplements
- Investigated and assessed wind and hail damages to homes
- Accurately processed and managed property claims through closeout to employer and client satisfaction
- Proficiently utilized X1 and Eagle View software.
- Exercises proper judgment and decision making to analyze the claims exposure to determine the proper course of action and to appropriately settle the claim.
- Interacts extensively with various parties involved in the claim process.
- Handles claims consistent with clients' and corporate policies, procedures and "best practices" and also in accordance with any statutory, regulatory and ethics requirements.
- Documents and communicates all claim activity timely and effectively and in a manner which supports the outcome of the claim file.
- Incumbents at this level should be able to work at full case load capacity.
- Assessed policy coverage, contacted insured, determined and established reserve requirements.
- Reviewed and set-up claims and described the loss to reflect actual circumstances.
- Determined the need for independent adjusters.
- Reviewed estimate of damages, issued payments, and settled claims.
Texas Freeze – Residential Claims
JD Claims
02.2021 - 05.2021
- Consistently provided excellent customer service to policy holders after suffering a loss by working closing with all internal departments to determine and apply appropriate coverage.
- Collaborated with SIU and Subrogation departments to identify potential fraud and subrogation opportunities.
- Quickly settled third-party property liability claims, along with property damage, theft, and jewelry claims.
- Developed and delivered training to all employees within the unit.
- Worked with and negotiated with various vendors to oversee replacements and repairs.
- Worked in concert with customers and agents to negotiate settlements and manage the customer experience.
- Collaborated with contractors, technicians and vendors on complex losses to come to equitable and accurate
- Used and managed vendors and experts in a cost-efficient manner.
- Handled property claims involving investigation, coverage, liability and compensability and resolved, recognizing appropriateness of settling, compromising or declining coverage.
- Coordinated and managed field investigations, outside engineers, contractors and cause and origin experts; and reconciled appropriateness and accuracy of costs and fees.
- Documented all aspects of claims, determined repair cost, replacement cost versus actual cash value, utilized replacement sources, completed proper reserving and issued payment transactions.
- Provided verbal and written reports and explanations on claims, process and status reports to insureds, claimants, agents, and other interested parties.
- Selected as member of the Claims Conversion team to test and implement new claims handling system.
Residential Hail Claims
CRU – TD Bank
Toronto, CN
07.2020 - 09.2020
- File review of submitted claims.
- Approval/Denial of claims and Supplements.
- Review of estimates in Xactimate, approval or denial of items per company guidelines.
- File corrections of claim submitted documents to match insurance policy guidelines.
- Set appropriate reserves based on Adjusters recommendation.
- Issued payment for approved claims.
- Manages claims through well-developed action plans to an appropriate and timely resolution.
- Assesses liability and resolves claims within evaluation.
- Negotiates settlement of claims within designated authority.
- Calculates and assigns timely and appropriate reserves to claims;
- Manages reserve adequacy throughout the life of the claim.
- Calculates and pays benefits due; approves and makes timely claim payments and adjustments; and settles clams within designated authority level.
- Prepares necessary state filings within statutory limits.
- Manages the litigation process; ensures timely and cost effective claims resolution.
- Coordinates vendor referrals for additional investigation and/or litigation management.
- Uses appropriate cost containment techniques including strategic vendor partnerships to reduce overall cost of claims for our clients.
- Manages claim recoveries, including be not limited to subrogation
- Reports claims to the excess carrier; responds to requests of directions in a professional and timely manner.
- Communicates claim activity and processing with the claimant and the client; maintains professional client relationships.
Bodily Injury Claims Adjuster liability, Complex BI, Represented Claims and Non-Represented Claims, Workers Compensation Consultant
State Farm Insurance
Bloomington, IL
09.2019 - 02.2020
- Make offer to Attorney's and claimants vs demands on represented and non-represented claims.
- Negotiate settlement of Bodily Injury base on medical bills, Lost Wages and Pain & Suffering.
- Coverage determination, liability investigation and analysis including comparative negligence.
- Taking recorded statements, documentation of files.
- Request property damage appraisals.
- Review medical records and bills to make bodily injury evaluation, validate accuracy and negotiate settlement with attorney’s or directly injured party complete bodily injury evaluations summary including causation, diagnosis treatment and general damages identify and forward files to subrogation.
- Refer questionable and suspicious claims to SUI
- Reduced loss ratios through fair and prompt processing of claims
- Works closely with employees to ensure that all relevant completed medical documentation is submitted for timely review
- Maintains appropriate contact with all employees on leave and coordinates all aspects of return to work for employees on leave including reasonable accommodation
- Produces and manages reporting metrics and analytics for all leave cases and workers’ compensation claims. Presents reports as requested
- Partners closely with all HR business partners and legal team on reasonable accommodation, all leave cases and workers’ compensation claims
- Meets regularly with HR business partners and business partners to review claims’ status and develops strategies for resolution
- Assists in the creation and facilitation of leave administration, workers’ compensation training and safety training programs
- MS Office products
Claims Adjuster hail, wind, water, freeze, Hurricane Barry
ASI Insurance Co.
Nashville, Tn
03.2019 - 08.2019
- Analyzes and manages complex or technically difficult claims by investigating and gathering information to determine the exposure on the claim; manages claims through well-developed action plans to an appropriate and timely resolution.
- Assesses liability and resolves claims within evaluation.
- Negotiates settlement of claims within designated authority.
- Calculates and assigns timely and appropriate reserves to claims; manages reserve adequacy throughout the life of the claim.
- Calculates and pays benefits due; approves and makes timely claim payments and adjustments; and settles clams within designated authority level.
- Prepares necessary state filings within statutory limits.
- Manages the litigation process; ensures timely and cost effective claims resolution.
- Coordinates vendor referrals for additional investigation and/or litigation management.
- Uses appropriate cost containment techniques including strategic vendor partnerships to reduce overall cost of claims for our clients.
- Manages claim recoveries, including be not limited to subrogation, reports claims to the excess carrier; responds to requests of directions in a professional and timely manner.
- Communicates claim activity and processing with the claimant and the client; maintains professional client relationships.
- Ensures claim files are properly documented and claims coding is correct.
- Refers cases as appropriate to supervisor and management.
Claims Adjuster Hurricane Irma, Florence, Michael
Citizens Property Insurance Corporation
Jacksonville, FL
08.2018 - 11.2018
- Review Claims presented by Field Adjusters.
- Approve Payment in, collaborate in Xactimate to make changes to current estimate.
- Issue partial or Full Denial Letters.
- Communicate with 3rd parties PA, Attorneys, Contractors and negotiate amical resolutions.
- Interpret Policies and apply to the claim submitted to mitigate claim, set reserves.
- Issue Reservation of Rights when required.
- Recommend claims for Appraisal.
Claims Examiner Hurricane Maria (Puerto Rico)
Mapfre Insurance
01.2018 - 02.2018
- File review of submitted claims.
- Approval/Denial of claims and Supplements.
- Review of estimates in Xactimate, approval or denial of items per company guidelines.
- File corrections of claim submitted documents to match insurance policy guidelines.
- Set appropriate reserves based on Adjusters recommendation.
- Issued payment for approved claims.
Claims Examiner Wind Claims Hurricane Irma
Florida Peninsula
Boca Raton, FL
10.2017 - 12.2017
- File management claim ownership Sugar CMS.
- Review of claim from Wind created damage associated with Hurricane Irma.
- Approval or Denial of claim submitted for INDEPENDENT Field adjusters.
- Contact Insureds regarding claim resolution.
- Creation of approval/denial letters per Insurance policy.
- Submission of Supplements to Carriers for additional damage.
- Review of estimates in Xactimate, approval or denial of items per company guidelines.
- File corrections of claim submitted documents to match insurance policy guidelines.
Claims Examiner-Hurricanes Harvey and Irma Flood Claims
NFIP
Overland Park, KS
08.2017 - 10.2017
- Examination of Claims Files submitted by Independent Field Adjusters.
- Review of Property and Contents damage claimed as a loss.
- Authority level 50k.
- Approval of Fema regulated claims.
- Utilization of ClaimsXchange.
- Flood Pro claims management system.
- Review and approval/denial of Preliminary Reports.
- Review of Final Reports and if approved issued Final Payment for adjudication of the claim.
- Set appropriate reserves based on Adjusters recommendation.
- Created claims from First Notice of Loss.
- Made initial call and made advanced payment to insureds.
- Maintained claim ownership from inception to completion/close.
Claims Adjuster-Commercial, Residential, Auto, Total Loss, Workers Compensation
Southern Company
06.2017 - 08.2017
- Adjusted Commercial claims based on review of contracts signed by Gas Co and Subcontractors.
- Handled Total Loss Auto Claims.
- Filed Subrogation on all claims meeting the guidelines.
- Negotiated Settlements.
- Sent Reservation of Rights on appropriate claims.
- Maintained Claim ownership to completion.
- Interpreted contracts and sent tender letter to Subcontractors and Subsidiary Companies.
- Utilization of Riskmaster Claims Management System.
- Set up Claimants for rental through HRAC.
- Ran reports through Lexis Nexis.
- Utilization of CMA, GMAC and Julie Tickets to determine liability.
- Made liability decision based on appropriate State Laws.
- Coordinate reporting and investigation of work injuries with Operations and Safety
- Report new work injuries to Third Party Administrator
- Monitor claim handling activity by Third Party Administrator
- Monitor, analyze, and report to internal client reserves and reserving activity (including reserving internally)
- Establish and maintain internal electronic files, including notes, records, statements, and correspondence
- Establish and monitor relationships with outside vendors and monitor expenditures for cost effectiveness
- Establish and monitor relationships with outside legal counsel and monitor expenditures for cost effectiveness
- Identify “best value” metrics in carriers and providers
- OSHA and various state-level compliance and including reporting, postings, panels, internal reporting, and other internal communication
Claims Adjuster – Total Loss
State Farm through The BestIRS
12.2016 - 03.2017
- Handled Total Loss Claims through the ECS system.
- Packaged and bundled the correct forms.
- Assigned tasks to TDP.
- Calculated figures and presented to 1st and 3rd party claimants.
CLAIMS ADJUSTER-PROPERTY DAMAGE
AMERICAN INDEPENDENT COMPANIES
MARIETTA, GA
06.2016 - 12.2016
- Interpret Negligence Laws.
- Analyzed first and third party claims to determine extent of company's liability.
- Reviewed and analyzed suspicious and potentially fraudulent insurance claims.
- Evaluated all evidence with the ultimate goal of creating positive outcomes for client's claims. Evaluated insurance policies and analyzed damages to determine coverage.
- Conduct prompt and thorough investigations, evaluate facts, interpret laws and regulations, and rendered determinations.
- Adhered to all statutory and regulatory fair claims practices.
- Recognized and identified potential fraudulent claims.
- Developed and maintained strong business relationships with internal and external customers.
- Served as a technical resource to lesser experienced Adjusters.
- Contributed to reaching customer service satisfaction goals following company protocol and providing exceptional customer service.
CLAIMS SPECIALIST PROPERTY DAMAGE/AUTO
STATE FARM AUTO
DUNWOODY, GA
07.2013 - 06.2016
- Analyzed first and third party claims to determine extent of company's liability.
- Received and reviewed claim information Applying claims settlement procedures to process claims, initiate claim payments, and close claim files.
- Communicated with customers and associates over the telephone and other communication channels to resolve claims.
- Successful completion of required training programs and all licensing requirements
- Reviewed and analyzed suspicious and potentially fraudulent insurance claims.
- Evaluated all evidence with the ultimate goal of creating positive outcomes for client's claims.
- Evaluated insurance policies and analyzed damages to determine coverage.
- Conduct prompt and thorough investigations, evaluate facts, interpret laws and regulations, and rendered determinations.
- Adhered to all statutory and regulatory fair claims practices.
- Recognized and identified potential fraudulent claims.
- Developed and maintained strong business relationships with internal and external customers.
- Served as a technical resource to lesser experienced Adjusters.
- Contributed to reaching customer service satisfaction goals following company protocol and providing exceptional customer service.
Education
Health Information Management
University of Alabama At Birmingham
Birmingham, ALAssociate of Science - Health Information Technology
DeVry University
Decatur, GASkills
Skills Insurance policy coverage knowledge Personal, Casualty and property loss
Property Claims Specialist Automobile claimsspecialist
Data analysis Advanced computer skills
California Jurisdictional Law and compliance New York Jurisdictional Law and Compliance
Oracle Database Excel Certified
HUD CERTIFIED USAA
LIGHTHOUSE TOWER HILL
FEDERATED NATIONAL CITIZENS
ENVIRONMENTAL ADJUSTERII
LLM (Large Language Model)
ML (Machine Learning)
Certification
- CIE - Certified Insurance Examiner
- CIFR - Certified Insurance Fraud Representative
- CIFA - Certified Insurance Fraud Analyst
Timeline
Claims Examiner – Flood Claims Hurricanes Beryl, Helene and Milton
Torrent – WYO/NFIP
10.2024 - 01.2026
WCCS – Deployed – Field Adjuster
State Farm Insurance
02.2024 - 10.2024
Complex Claims Adjuster
American Family Insurance
08.2023 - 02.2024
Liability Claims Adjuster
Commonwealth Insurance
03.2023 - 05.2023
Claims Adjuster
UPC Insurance
11.2022 - 02.2023
Residential Auto Claims
The Littleton Group – Progressive
07.2021 - 09.2022
Virtual Residential Claims Adjuster
Crawford – Allstate
05.2021 - 07.2021
Texas Freeze – Residential Claims
JD Claims
02.2021 - 05.2021
Residential Hail Claims
CRU – TD Bank
07.2020 - 09.2020
Bodily Injury Claims Adjuster liability, Complex BI, Represented Claims and Non-Represented Claims, Workers Compensation Consultant
State Farm Insurance
09.2019 - 02.2020
Claims Adjuster hail, wind, water, freeze, Hurricane Barry
ASI Insurance Co.
03.2019 - 08.2019
Claims Adjuster Hurricane Irma, Florence, Michael
Citizens Property Insurance Corporation
08.2018 - 11.2018
Claims Examiner Hurricane Maria (Puerto Rico)
Mapfre Insurance
01.2018 - 02.2018
Claims Examiner Wind Claims Hurricane Irma
Florida Peninsula
10.2017 - 12.2017
Claims Examiner-Hurricanes Harvey and Irma Flood Claims
NFIP
08.2017 - 10.2017
Claims Adjuster-Commercial, Residential, Auto, Total Loss, Workers Compensation
Southern Company
06.2017 - 08.2017
Claims Adjuster – Total Loss
State Farm through The BestIRS
12.2016 - 03.2017
CLAIMS ADJUSTER-PROPERTY DAMAGE
AMERICAN INDEPENDENT COMPANIES
06.2016 - 12.2016
CLAIMS SPECIALIST PROPERTY DAMAGE/AUTO
STATE FARM AUTO
07.2013 - 06.2016
Health Information Management
University of Alabama At Birmingham
Associate of Science - Health Information Technology
DeVry University