Multi-line Claims Supervisor dedicated to quality investigation, adjustment and supervision of diverse cases. Blends strategic planning and leadership strengths to establish top-performing claims departments. Trains and mentors staff, optimizing compliance with policies, procedures and applicable laws.
Overview
29
29
years of professional experience
Work History
Liability Claims Supervisor
Gallagher Bassett Services Inc.
02.2022 - Current
Direct management of a talented team of five claims adjusters dedicated to timely and compliant resolutions of claims with an average pending of 125 per adjuster.
Monitor performance and enforce compliance with corporate claims processes and procedures and best practices.
Document and communicate timely claims information while supporting adjusters outcomes with all parties and insures all claims are processed a timely and accurate manner. Confirm that all contacts have been completed within 24 hours to insureds, witnesses, third party claimants, attorneys, etc. Verify coverage and obtain a police report if applicable and determine liability as well as posting reserves.
Handles commercial policies with limits up to 5 million dollars,
Championed insurance claims process by providing expert knowledge and building positive, trusting relationship with liability adjusters, clients, third parties, attorneys, etc.
Responsible for reviewing all new claims as reported and continue follow ups on diaries until a claim has been resolved.
Actively executes appropriate claims activities to ensure consistent delivery of quality claims service.
Complete one on one training once per week with each adjuster as well as team meetings.
Compliance with state laws and regulations regarding claim handling as well as licensing
Reviews insurance forms for accuracy and completeness and will contact other parties as needed.
Comes up with action plans and training to adjusters to maintain quality in handling files.
Responsible for answering Department of Insurance complaints.
Reviews coverage denials for accuracy.
Handles large losses.
Licensed in every state except Hawaii
Liability Claims Supervisor
OOIDA
01.2013 - 02.2022
Full Liability Investigations by confirming coverage, statements from insureds, claimants, witnesses, obtaining police reports, determine liability and send appropriate denial and/or coverage denials. Handles large bodily injury claims with authority up to $100,000.00. OOIDA insures commercial vehicles with a CSL of $1,000,000.00. Maintaining appropriate reserves at all times. Currently have a pending of 84 as well as my supervisor duties.
Licensed in all states except Hawaii and Alaska.
Supervisor of five liability adjusters and one medical specialist.
Assign defense counsel in each state for serious injury claims, litigated claims, surveillance and work direct with defense counsel until the completion of litigated files.
Reviews all new claims assigned to an adjusters and continue to monitor certain files that can be difficult. Our adjusters have pendings ranging from 125 to 150 and continue to review files on a monthly basis for complicated claims. Gives guidance and suggestions on handling difficult claims. Monitors settlement discussions between claimants and attorneys to verify the team members are complying with the company's fiduciary requirements
Respond to DOI complaints from any states if needed.
Negotiated disputed bills or invoices and achieving successful resolution.
Exceeded clients' expectations by compassionately gathering required medical and work history information to complete PIP and Medical Payment coverages.
Performed spending analysis and partnerships to refine policies and develop recommendations for improvement.
Cultivated productive relationships with stakeholders, facilitating claims lifecycle.
Determined proper course of action for claims processing.
Championed insurance claims process by providing expert knowledge and building positive, trusting relationship to support clients during challenging times.
Optimized case management with establishment of best practices.
Investigated, evaluated and adjusted multi-line claims in accordance with standards and laws.
Documented and communicated timely claims information while supporting accurate outcomes.
Liability Claims Adjuster
Traders Insurance
08.2000 - 06.2008
Examined claims forms and other records to determine insurance coverage.
Maintained suspicious claims database and prepared reports for supervisor to determine rescission of a policy.
Evaluated all evidence with ultimate goal of creating positive outcomes for client's claims.
Handled bodily injury and property damage claims from beginning to end. Completed bodily injury reviews in order to resolve a claim with the best possible resolution.
Reviewed new files to determine current status of injury claim and to develop plan of action.
Verified insurance claims and determined fair amount for settlement.
Investigated and assessed damage to property and reviewed property damage estimates.
Maintained contact with claimants and attorneys to determine treatment status.
Conducted comprehensive interviews of witnesses and claimants to gather facts and information.
Prepared summaries of damage, payments and policy coverage.
Litigation Specialist
Mercury Insurance
08.1997 - 06.2000
Maintained litigation docket and calendars to verify processes with defense counsels, noting deadlines for responsive pleadings, motions and other important deadlines.
Supported administration and research processes for civil litigation cases.
Answered telephone and coordinated meetings and conferences.
Provided key administrative assistance to senior management.
Worked closely with litigation attorneys
Continue to update reserves based upon defense counsels evaluation of settlement ranges and expense costs.
Attended some court conferences.
Kept up-to-date on case progress by frequently reviewing records and reporting findings to clients.
Field Adjuster
Mercury Insurance
09.1995 - 08.1997
ordered police reports, medical treatment records and physical property damage to determine extent of liability.
Made recommendations to manager on damages exceeding adjuster's authority.
Reviewed bills, estimates and proofs of loss prior to making settlement and payment of claim.
Updated claim database system with proper and adequate coding and documentation.
Identified insurance coverage limitations with thorough examinations of claims documentation and related records.
Collected and tracked evidence in support of legal processes.
Evaluated original investigation reports and documents to resolve secondary concerns.
Evaluated all evidence with ultimate goal of creating positive outcomes for client's claims.
Reviewed new files to determine current status of injury claim and to develop plan of action.
Conducted thorough property investigations to identify and classify damages for customer claims.
Reviewed and analyzed suspicious and potentially fraudulent insurance claims.
Directed and coordinated various investigations conducted by field investigation team.
Determined liability outlined in coverage and assessed documentation such from police and healthcare providers to understand damages incurred.
Investigated and assessed damage to property and reviewed property damage estimates.
Maintained contact with claimants and attorneys to determine treatment status.
Handled all types of calls from customers and other stakeholders about claims processes.
Negotiated property damage and bodily injury settlement agreements to resolve disputes.
Resolved complex, severe exposure claims using high service oriented file handling.
Organized, planned, and documented materials for concluding claims.
Delivered exceptional customer service to policyholders by communicating important information and patiently listening to all issues.
Read over insurance policies to ascertain levels of coverage and determine whether claims would receive approvals or denials.
Researched claims and incident information to deliver solutions and resolve problems.
Examined claims forms and other records to determine insurance coverage.
Conducted comprehensive interviews of witnesses and claimants to gather facts and information.
Visited customer locations to evaluate damage and provided cost estimates for remediation.
Conducted field investigations to include in person interviews, scene investigators and property damage photos.
Resolved complex bodily injury claims by evaluating all medical records and billings.
Negotiated property damage and bodily injury settlement agreements to resolve disputes.
Ordered and personally picked up police reports, medical treatment records and physical property damage to determine extent of liability/damages.
Liability Claims Adjuster
Mercury Insurance
08.1994 - 09.1995
Examined claims forms and other records to determine insurance coverage.
Prepared summaries of damage, payments and policy coverage.
Answered questions posed by insured and attorneys.
Reviewed and analyzed suspicious and potentially fraudulent insurance claims.
Conducted comprehensive interviews of witnesses and claimants to gather facts and information.
Reviewed new files to determine current status of injury claim and to develop plan of action.
Reviewed police reports, medical treatment records as well as property damage claims to determine the extent of liability.
Directed and coordinated various investigations conducted by field investigations.
Organized, planned, and documented materials for liability, property and bodily injury claims.
Evaluated insurance policies and analyzed damages to determine coverage.
Evaluated all evidence with ultimate goal of creating positive outcomes for client's claims.
Maintained contact with claimants and attorneys to determine treatment status.
Reviewed field inspections and coordinated all insurance claim audits.
Documented all investigation activity and presented reports to management.