Ericka Riles
Atlanta,GA
Summary
Self-motivated individual with problem solving, investigating, negotiating, and decision-making skills pursuing a career within an organization that offers opportunity for growth. Flourishes in both independent and collaborative environments.
Overview
17
17
years of professional experience
1
1
Certification
Work History
Liability Claims Adjuster
United Automobile Insurance Company
Miami, FL
06.2024 - Current
- Maintained detailed records for each claim, ensuring accuracy and completeness for future reference and audit purposes.
- Established rapport with policyholders through clear communication, empathy, and professionalism during difficult circumstances.
- Reduced claims processing time by implementing efficient workflow strategies and prioritizing tasks.
- Collect relevant information, such as photographs, statements, police reports, and any other documentation necessary for assessment.
CLAIMS ADJUSTER
Liberty Mutual Insurance
Atlanta
07.2022 - 02.2024
- Investigating, evaluating, and settling auto insurance claims
- Review medical records, police reports, and other documents related to the claim
- Collaborate with SIU department to decipher questionable claims
- Proactively investigating claims
- Applying policy coverage/ explained liability decisions
- Accurately dementing claim files
- Set up repairs, rental and tow for policy holders and claimants.
GAP CLAIMS ADJUSTER
Safeguard Products International
Atlanta
06.2021 - 01.2022
- Calculates claim proceeds in accordance with GAP contract coverage by analyzing and reviewing borrowers loan history, MSRP/NADA valuations and primary insurance coverage documentation
- Request additional documents to assist in determination of a claim
- Examines and adjusts GAP claims to include coordinating all claims related activities and processing payments to lenders
- Investigating, evaluating and settling claims
- Obtain and prepare the necessary documentation associated with the prompt, accurate, and thorough verification of losses and administration of claims.
CONTENT CUSTOMER SERVICE REPRESENTATIVE/CLAIMS ADJUSTER
Safe Guard Products International
Atlanta
07.2018 - 06.2021
- Handle between 40-50 inbound calls from external customers related to claims processing
- Data Entry in multiple Microsoft applications
- Reporting of losses for the policyholder, lien holders and dealerships
- Explained GAP coverage in detail to customers
- Adhered to established policies, procedures and compliance for satisfactory audit rating
- Investigated and resolved accounting, service and delivery concerns
- Maintained up-to-date knowledge of product and service changes
- Review and accept documents for customer claim.
CLAIMS INTAKE REPRESENTATIVE
Access Holdco Management
Dunwoody
10.2017 - 05.2018
- Handled between 60-90 inbound first notices of loss and existing claims calls
- Ensured exceptional customer service by addressing customer concerns, demonstrated empathy, and resolving one call resolutions
- Service calls from insureds, claimants, attorneys and others to resolve claims related inquiries
- Enters loss information into appropriate claims applications
- Ensure company and departmental policies, procedures and service standards are consistently followed
- Report potential fraud and/or unusual trends
- Forward any unresolved questions to appropriate departments.
CLAIMS ADJUSTER
State Farm
Atlanta
03.2016 - 06.2017
- Handled between 20-40 inbound calls related to claims matters
- Exceeded all metrics while performing duties of a claims associate
- Worked in a collaborative team environment while meeting quality standards
- Explained coverage/ liability and initiate auto process for payments as warranted
- Assisted policy holders and claimants with rental/repair/tow options for auto claims
- Experienced in handling multi-state standard lines of insurance
- Built rapport and resolved customer issues through superior service and maintained client faith in State Farm
- Identified insurance coverage limitations with thorough examinations of claims documentation and related records
- Tracked progress of all outstanding insurance claims.
PATIENT SERVICE REPRESENTATIVE
Aetna/ CVS Caremark
Pompano Beach, FL
08.2007 - 12.2012
- Handled 90+ incoming calls from members and providers regarding claim status, benefits, eligibility, and pharmacy orders
- Provided order status, completed refill requests, and resolved complicated issues involving multiple departments within the Pharmacy
- Ensured accurate information was provided to customers in a timely manner
- Built rapport, effective listening skills clarify and manage conversational flow
- Educated patients on medicine and at-home healthcare tools
- Explained plans for treatment and payment options.
Education
Bachelor of Science - Business Administration and Management
Strayer University
Morrow, GA05.2021
Skills
- Data Entry/10-Key/Alphanumeric
- Dual Monitor
- Navigating 4-6 application simultaneously
- Experienced with Microsoft: Word, Excel, Power Point, Outlook
- Excellent customer service skills
- Insurance policy coverage knowledge
Certification
Certified Pharmacy Technician (CPhT)
Professional License
- Adjuster License, All Lines Designated, TX
- Claim Handler all Lines, CT
- Property & Casualty, SC
- NH, OK, VT Property Motor Vehicle Casualty, DE
- General Lines, WY Adjuster Fire and Auto, GA
Timeline
Liability Claims Adjuster
United Automobile Insurance Company
06.2024 - Current
CLAIMS ADJUSTER
Liberty Mutual Insurance
07.2022 - 02.2024
GAP CLAIMS ADJUSTER
Safeguard Products International
06.2021 - 01.2022
CONTENT CUSTOMER SERVICE REPRESENTATIVE/CLAIMS ADJUSTER
Safe Guard Products International
07.2018 - 06.2021
CLAIMS INTAKE REPRESENTATIVE
Access Holdco Management
10.2017 - 05.2018
CLAIMS ADJUSTER
State Farm
03.2016 - 06.2017
PATIENT SERVICE REPRESENTATIVE
Aetna/ CVS Caremark
08.2007 - 12.2012
Bachelor of Science - Business Administration and Management
Strayer University