Elizabeth Hoffman

Work directly and support assigned public entity clients, exercising independent judgment and personal discretion on matters related to general liability claims, claims management, and claims resolution/settlement.

Investigate, analyze, and determine the extent of the insurance provider's liability concerning personal, casualty, or property loss or damages.

Recommend claims action and setting and adjusting proper reserves as appropriate while complying with accepted guidelines regarding reserve practice and authority levels.

Communicate with claimants, clients, and attorneys throughout the claims process.

Correspond with, and interview medical specialists, agents, witnesses, or claimants to compile information.

Create and maintain records, diaries, and reports in the claims system and/or the client's system.

Negotiate claim resolutions and approve payments, within a certain monetary limit.

Collaborate with counsel in preparation for litigation including assembling evidence to support contested claims and keeping clients advised of litigation status.

Conduct and managed on-site insurance property claim inventory assignments and complete field inventory processes. Complete all tasks assigned in a diligent manner consistent with department, faculty or operation and corporate goals and objectives. Assist in business development activities in conjunction with new and existing service offerings. Promote, build and maintain good customer relations with adjusters assist in retention and repeat use. Commutate with Field manager and Service Manager daily with regards to operational issues and/ or improvements.

Follow all standard operating and safety procedures, written and oral always. Interacts with policyholders, agents, adjusters, restoration companies, public adjusters, independent adjusters and fraud investigators to compile and coordinate to complete each claim. Achieved invaluable Property and Casualty claim experience.

Conducts onsite field investigations of large loss claims and coordinates rebuilding of damages with various trades I vendors / independent adjuster. Complete onsite Xactimate - Xactcontents estimates, through investigation, photos, and narrative reports. Obtain reports and appraisals of personal property

damage $200,000 - $1,000,000+. Document claim file by interview with persons associated with the

case, recorded statements and police reports. Accurately pays claims based on policy provisions, state mandates and I or fee schedules. Authorizes and I or approves all claim payments within granted authority associated with claim. Partner with SIU to assist in preparing and review files for possible trials. Maintains current local knowledge of the individual eleven (11) greater Western states that are covered.

Conduct and managed on-site insurance property claim inventory assignments pursuant to SOS field inventory processes. Complete all tasks assigned in a diligent manner consistent with department, faculty or operation and corporate goals and objectives. Assist in business development activities in conjunction with new and existing service offerings. Promote, build and maintain good customer relations with adjusters assist in retention and repeat use. Commutate with field manager and Service Manager daily with regards to operational issues and/ or improvements.

Follow all standard operating and safety procedures, written and oral always.Interacts with policyholders, agents, adjusters, restoration companies, public adjusters, independent adjusters and fraud investigators to compile and coordinate to complete each claim. Achieved invaluable Property and Casualty claim experience.

Provided telephonic engagement and coordinate care for disabled members under Anthem Blue Cross. Provide customer service to members, providers and peers. Work with license clinical staff to help members manage their health and maintain healthy goals. Complete inbound and outbound calls to members to assist with medical management issues. Interacted with software to find, engage, intervene and maintain results with the high and moderate risk members. Focus on care coordination and outcomes based on claim data provided from the state of California. Coordinated a Full Call Center environment management team to assure appropriate utilization of healthcare services by medically and socially complex plan members. Go to member for questions or resolving problems regarding benefit plan s, patient eligibility, authorizations, referrals, for Medi-Cal members and to manage card for Anthem Blue Cross.

Provided assistance to clients

• Answered phone and assisted Insured's with changes on the policies.

•Scheduled reservations for customers

•Maintained up-to-date knowledge of customer accounts •Operated the cash drawer

Explained products and benefits •Confirmed payments, refunds, etc. •Assisted customers in person

• Assisted Personal lines and Commercial lines on endorsements. Upload policies to the appropriate

company and complete and underwriting request.

• Provided assistance to clients

• Answered phone and assisted customers with changes

• Assisted customers in person

• Created customer appointments

• Scheduled reservations for customers

•Maintained up-to-date knowledge of customer accounts

• Explained products and benefits

• Operate the cash drawer Confirmed payments, refunds, and resolve payment disputes

Evaluated, investigated and adjusted first party claims and third party property damage claims in a timely an efficient manner as to prevent unnecessary expense to the company and policy holders. Investigate claim through prompt contact with appropriate parties such as policyholder, accounts, claimants, law enforcement agencies, witnesses, agents, medical providers, technical experts and attorneys to determine the extent of liability, damages and contribution potential. Take statements to analyze and evacuate relevant information essential in resolving all exposures on a claim. Verify the nature an extent of injury or property damage by obtaining and reviewing appropriate records. Oversee all components of the claim process to properly evaluate, negotiate and settle claims within authority levels. Manage litigate claims and develop a litigation plan with staff or panel counsel and control legal expenses.

Assisted pharmaceutical inquiries with AS400 to resolve pharmacy inability to provide correct mediation / billing to client. Respond to inquiries from providers, plans member and provided professional assistance from PPO, HMO, Tricare, Medicare nationwide. Work with trainers and management to create standardized procedures and disseminate the information to the service representatives.

Achieved and maintained exceeds standards in yearly performance evaluations. Caremark selected highest performers to open new call centers. I was selected to open new call center in Tennessee and train representatives.

Underwriting for the Western Region. Completed underwriting coarse to comply with policy for inbound and outbound calls from Customers and Agents to assist in any underwriting resolutions. Responsible for rating, endorsements, cancellations, policy insurance, data entry and other underwriting decisions. Certified bilingual interpreter for all departments nationwide.