Felisha Davis
Kingwood
Summary
With over two decades at the forefront of the insurance industry, I've honed my expertise in complex claims and risk mitigation. My background showcases a blend of strategic problem-solving and a positive attitude, driving significant improvements in claims processing efficiency and customer satisfaction.
Overview
16
16
years of professional experience
1
1
Certification
Work History
Complex Claims Expert
Kemper Insurance
Remote
05.2022 - Current
- Review and analyze Home Office referrals for personal auto, commercial auto, and general liability claims with limits up to $1,000,000 CSL.
- Work closely with coverage counsel, corporate litigation, and panel counsel to complete risk analysis on claim files
- Direct company personnel to perform specific tasks for effective claim handling.
- Consult with the claims branch to mitigate risk for the insured and the company by completing a detailed review of complex and serious injury claim files in their entirety and providing detailed expert direction.
- Analyze and direct handling of coverage positions and confirm or deny coverage as needed.
- Coordinate and direct investigations into the facts of the loss, and the extent of damages or injuries.
- Ensure all necessary documentation of damages is obtained based on the nature of the claim.
- Evaluate information on contractual coverage, liability, and damages to determine exposure to the insured.
- Document investigation, evaluation, strategies, and resolutions of claims through various means of communication.
- Review and set reserves within authority or recommend changes to higher management for approval.
- Conclude claims by communicating coverage and liability positions and directing settlement negotiations.
Casualty Claims Adjuster
Kemper Insurance
Remote
10.2016 - 05.2022
- Interpreted policy language, policy endorsements and applied relevant state laws in making decisions on claims.
- Conducting coverage and liability investigations by interviewing named insureds, insured drivers, claimants and witnesses, reviewing vehicle damages, and obtaining accident reports.
- Developed strategies to improve customer service to external customers while controlling costs associated with claims processing.
- Identified potential areas of fraud by recognizing patterns or inconsistencies in claim data.
- Reviewed medical records and other documentation in order to evaluate the extent of losses.
- Managed appropriate reserves on open claims while ensuring timely resolution within established guidelines.
- Maintained detailed records of all claim activity including investigation results, settlement negotiations, payments.
- Negotiated settlements with claimants or their legal representatives.
- Conducted periodic reviews of existing procedures and practices related to claims handling in order to identify opportunities for improvement.
- Collaborated with internal departments such as underwriting and risk management to ensure that appropriate action is taken on each claim.
- Analyzed claim information to determine coverage of insurance policies.
Casualty/Major Loss Claims Adjuster
Direct General Insurance
Irving
08.2014 - 10.2016
- Interpreted policy language, policy endorsements and applied relevant state laws in making decisions on claims.
- Conducting coverage and liability investigations by interviewing named insureds, insured drivers, claimants and witnesses, reviewing vehicle damages, and obtaining accident reports.
- Developed strategies to improve customer service to external customers while controlling costs associated with claims processing.
- Identified potential areas of fraud by recognizing patterns or inconsistencies in claim data.
- Reviewed medical records and other documentation in order to evaluate the extent of losses.
- Managed appropriate reserves on fatality claims, high exposure, and significant injury open claims while ensuring timely resolution within established guidelines.
- Maintained detailed records of all claim activity including investigation results, settlement negotiations, payments.
- Negotiated settlements with claimants or their legal representatives.
- Conducted periodic reviews of existing procedures and practices related to claims handling in order to identify opportunities for improvement.
- Collaborated with internal departments such as underwriting and risk management to ensure that appropriate action is taken on each claim.
- Analyzed claim information to determine coverage of insurance policies.
- Participated in seminars and workshops designed to keep abreast of changes in laws affecting casualty insurance companies.
- Investigated, evaluated and determined liability for casualty claims.
- Advised customers on the status of their claim payments or denials.
- Reviewed policies to determine appropriate levels of coverage, and assist with approval or denial decisions.
- Recommended referral to litigation when appropriate.
- Reduced loss ratios through fair and prompt processing of claims.
Empower Insurance Group
Fort Worth
05.2014 - 08.2014
- Interpreted policy language, policy endorsements and applied relevant state laws in making decisions on claims.
- Conducting coverage and liability investigations by interviewing named insureds, insured drivers, claimants and witnesses, reviewing vehicle damages, and obtaining accident reports.
- Developed strategies to improve customer service to external customers while controlling costs associated with claims processing.
- Identified potential areas of fraud by recognizing patterns or inconsistencies in claim data.
- Reviewed medical records and other documentation in order to evaluate the extent of losses.
- Managed appropriate reserves on open claims while ensuring timely resolution within established guidelines.
- Maintained detailed records of all claim activity including investigation results, settlement negotiations, payments.
- Negotiated settlements with claimants or their legal representatives.
- Conducted periodic reviews of existing procedures and practices related to claims handling in order to identify opportunities for improvement.
- Collaborated with internal departments such as underwriting and risk management to ensure that appropriate action is taken on each claim.
- Analyzed claim information to determine coverage of insurance policies
Casualty Claims Adjuster
Gainsco Auto Insurance
Dallas
06.2009 - 05.2014
- Interpreted policy language, policy endorsements and applied relevant state laws in making decisions on claims.
- Conducting coverage and liability investigations by interviewing named insureds, insured drivers, claimants and witnesses, reviewing vehicle damages, and obtaining accident reports.
- Developed strategies to improve customer service to external customers while controlling costs associated with claims processing.
- Identified potential areas of fraud by recognizing patterns or inconsistencies in claim data.
- Reviewed medical records and other documentation in order to evaluate the extent of losses.
- Managed appropriate reserves on open claims while ensuring timely resolution within established guidelines.
- Maintained detailed records of all claim activity including investigation results, settlement negotiations, payments.
- Negotiated settlements with claimants or their legal representatives.
- Conducted periodic reviews of existing procedures and practices related to claims handling in order to identify opportunities for improvement.
- Collaborated with internal departments such as underwriting and risk management to ensure that appropriate action is taken on each claim.
- Analyzed claim information to determine coverage of insurance policies.
Education
Bachelor of Arts - Psychology
The University of Texas At Arlington
Arlington, TX12-2003
Skills
- Over 20 years of experience in insurance
- Management Experience
- Problem-solving
- Friendly, positive attitude
- Multitasking
- Analytical skills
Affiliations
- Involved in civil rights organizations
- Involved in multiple church ministries
Languages
English
Native/ Bilingual
Certification
- Texas Insurance license
- Georgia Insurance License
- Louisiana Insurance License
Accomplishments
- Involved currently in Emerging Leaders Program
References
References available upon request.
Timeline
Complex Claims Expert
Kemper Insurance
05.2022 - Current
Casualty Claims Adjuster
Kemper Insurance
10.2016 - 05.2022
Casualty/Major Loss Claims Adjuster
Direct General Insurance
08.2014 - 10.2016
Empower Insurance Group
05.2014 - 08.2014
Casualty Claims Adjuster
Gainsco Auto Insurance
06.2009 - 05.2014
Bachelor of Arts - Psychology
The University of Texas At Arlington
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