Gregory Sims
Garland
Summary
Results-driven Claims Adjuster with over 10 years of experience in auto insurance claims, specializing in Personal Injury Protection, Medical Payments, and bodily injury claims. Expertise in reviewing billing and medical records to assess claim value and conducting liability investigations. Skilled in comprehensive coverage analyses and settlement negotiations, ensuring compliance with industry regulations while maintaining strong client relationships.
Overview
1
1
Certification
10
10
years of professional experience
Work History
Personal Injury / PIP Adjuster
Geico
02.2025 - Current
- Administered PIP/MedPay and personal injury claim lifecycle, overseeing intake processing through resolution and settlement execution to maintain timeliness and fairness.
- Examined medical bills, HCFA/CMS-1500 forms, treatment records, and attorney demands to confirm claim accuracy and facilitate settlement negotiations.
- Performed comprehensive liability and coverage investigations by querying and analyzing multiple data systems.
- Handled settlement negotiations with a focus on policy and state regulatory requirements, reducing exposure to potential liabilities.
Workers’ Compensation Adjuster – Independent Assignment
AmTrust
03.2023 - 01.2025
- Assessed workplace injuries and analyzed third-party liability exposure, ensuring accuracy of filed claims.
- Prepared arbitration claims and filed documentation to pursue recovery of medical and indemnity payments for injured workers.
- Executed detailed accuracy reviews of medical billing, validating coding accuracy and supporting documentation standards for regulatory compliance and cost containment.
- Investigated incident reports, compiled documented findings, and assessed third-party liability exposure tied to workplace injuries.
Catastrophic Adjuster
Progressive
08.2020 - 02.2023
- Reviewed total loss claims and negotiated settlement amounts from $2,500 to $100,000.
- Coordinated vendor salvage logistics and maintained customer relationships to reduce friction within claims processing.
- Handled high-volume claims in Avaya systems workflow to maintain timely claim resolution.
- Reviewed, verified, and processed lienholder and POA documentation to maintain readiness for claim resolution.
- Evaluated claims to determine coverage and settlement amounts, ensuring compliance with policy guidelines.
- Investigated incidents through interviews, site visits, and evidence collection to assess claim validity.
Bodily Injury Adjuster – Independent Assignment
HallMark Insurance
11.2019 - 06.2020
- Monitored and managed high-volume BI and PIP claims workflow to drive timely claim resolution.
- Validated medical treatment plans and attorney demands for accuracy, completeness, and compliance with applicable requirements.
- Executed investigations in ISO and TLO systems to retrieve and document critical claim information.
- Performed investigations using ISO and TLO systems, applying required data inputs and system-based workflows.
- Evaluated bodily injury claims to determine settlement amounts based on policy coverage and legal guidelines.
- Collaborated with medical professionals to assess treatment costs and validate injury claims effectively.
Auto Liability Adjuster
Kemper
02.2017 - 11.2019
- Handled BI/PD liability and total loss claim investigations and resolutions to maintain timeliness and fairness.
- Conducted settlement negotiations with customer attorneys and vendors to reach agreed terms.
- Coordinated daily claim processing capacity for high-volume workload while verifying documentation accuracy for regulatory compliance.
- Evaluated auto liability claims, ensuring compliance with policy guidelines and regulations.
- Investigated accident reports and gathered evidence to determine liability and coverage issues.
Education
Bachelor of Science - Business
Prairie View College
Houston01-2010
Skills
- Claims resolution
- Injury claims resolution
- Claims processing
- Claims investigation
- Settlement negotiation
- Liability investigations
- Damage assessment
- Legal demand assessment
- HCFA review expertise
- Policy interpretation
- Regulations adherence
- Property valuation
Certification
Florida (FL) | Louisiana (LA) | Michigan (MI) | Connecticut (CT) | Delaware (DE) | New Hampshire (NH) | Oklahoma (OK) | Kentucky (KY) | South Carolina (SC) | Wyoming (WY) | Texas (TX) | Vermont (VT)
Timeline
Personal Injury / PIP Adjuster
Geico
02.2025 - Current
Workers’ Compensation Adjuster – Independent Assignment
AmTrust
03.2023 - 01.2025
Catastrophic Adjuster
Progressive
08.2020 - 02.2023
Bodily Injury Adjuster – Independent Assignment
HallMark Insurance
11.2019 - 06.2020
Auto Liability Adjuster
Kemper
02.2017 - 11.2019
Bachelor of Science - Business
Prairie View College