Jacqueline Matthews
Grand Prairie,TX
Summary
Results-driven professional with extensive knowledge of insurance regulations and compliance. Skilled in performing detailed claims investigations and evaluating damages to assess liability. Excellent communication and interpersonal skills with a talent for negotiating successful settlements and maintaining positive client relationships.
Overview
19
19
years of professional experience
1
1
Certification
Work History
Total Loss Claims Adjuster (State Farm Insurance)
Crawford & Company
Atlanta, GA
06.2022 - 11.2022
- Evaluated claims and performed investigation to accurately assess damages according to total loss threshold.
- Maintained accurate records of all activities related to total loss claims processing.
- Examined claim forms and other records to confirm coverage for loss of damage.
- Reviewed vehicle options, mileage and condition report to ensure fair and equitable settlement amount.
- Processed claim settlement payments within approved authority level.
Claims Adjuster (State Farm Insurance)
The Best Claims Solution
Phoenix, AZ
01.2022 - 04.2022
- Analyzed, evaluated and processed insurance claims to determine coverage, liability and damages in accordance with policy terms and state regulations.
- Made equitable liability decisions by regularly resolving disputes between policy holders and claimants.
- Conducted interviews and recorded statements with insureds, claimants and witnesses to facilitate fair claims investigation.
- Monitored claims handling by leveraging calendar management system, completing timely follow up with all parties.
- Analyzed, evaluated and processed insurance claims to determine coverage, liability and damages in accordance with policy terms and state regulations.
- Payed and processed approved claims within designated authority level.
Property ECTA (State Farm Insurance)
EA Renfroe
Pelham, AL
02.2021 - 12.2021
- Assisted Claim Owner with incoming calls from customers regarding claim update and payment status.
- Managed high-stress situations effectively, maintaining professionalism under pressure while resolving disputes or conflicts.
- Assisted with click to chat, responding to Agents request for claim status updates
- Assisted customers in navigating company website in setting up payment option.
Claims Adjuster (TD Insurance)
Catastrophe Response Unit
Toronto, Ontario
06.2020 - 11.2020
- Investigated, evaluated and settled claims applying technical knowledge and human relations skills to achieve fair and equitable settlement of claims.
- Maintained detailed records of all claim activities in a computer system for accurate tracking purposes.
- Generated comprehensive reports outlining claim progress, evaluations of damages, negotiations outcomes and final resolutions for review by management team.
- Entered claim payments, reserves and new claims in computer database, inputted concise yet sufficient file documentation.
- Processed claim payments within approved authority level.
Total Loss Claims Adjuster
Windhaven Insurance Company
Dallas, TX
09.2019 - 12.2019
- Reviewed police reports for accuracy when determining liability in total loss cases.
- Performed thorough investigations of total loss claims, ensuring accuracy and completeness of documentation.
- Applied knowledge of auto body repair techniques when evaluating repair costs for total losses.
- Negotiated settlements with claimants in accordance with company policies and procedures.
- Analyzed vehicle repair estimates, photographs, title information and other pertinent documents to evaluate claims.
- Evaluated salvage values for totaled vehicles using market data analysis tools.
Total Loss Claims Adjuster (State Farm Insurance)
The Best Claim Solution
Phoenix, AZ
03.2017 - 01.2019
- Analyzed vehicle repair estimates, photographs, title information and other pertinent documents to evaluate claims.
- Assigned appraiser for re-evaluation to resolve disagreement with repair facility on repair cost.
- Communication with various vehicle evaluation vendors; such as Mitchell, Autosource, NADA, as well as Salvage vendors IAA and Copart.
- Evaluated salvage values for totaled vehicles using market data analysis tools.
- Maintained accurate records of all activities related to total loss claims processing.
Claims Adjuster (State Farm Insurance)
Pilot Catastrophe Services
Mobile, AL
11.2015 - 10.2016
- Evaluated claims and performed investigations to accurately assess damages and liability.
- Handled difficult conversations professionally while maintaining composure during high-stress situations.
- Examined claim forms and other records to confirm coverage for loss or damage.
- Used strong customer service skills to negotiate with policyholders to settle claims.
- Reported overpayments, underpayment and other irregularities.
- Completed audit review for claim file closure.
Senior Credentialing QA Analyst
Federation of State Medical Board
Euless, TX
01.2004 - 04.2015
- Initiation, construction and quality assurance of credentialing portfolios for both Physician and Physician Assistants to be submitted to state medical boards for state licensure.
- Performed comprehensive review of applicant provided information and source verification for discrepancies and omissions.
- Audit Physicians profile according to internal policies and NCQA guidelines.
- Ensure accuracy and completeness of all verification received for Physician portfolio according to internal and external requirements.
- Interacted with internal work groups for additional verification and follow up for Physician permanent portfolio.
Education
Bachelor of Science (B.S.) in Computer Information Systems -
Grambling State University
Grambling, LA07.1987
Skills
- Insurance Policy Knowledge
- Damage Assessment
- Claims Investigation
- Attention to Detail
- Knowledgeable in ECS, Claims Experience, Queue Manager, Click to chat
- Customer Service expertise
- Mathematics Proficiency
- Critical Thinking
- Computer Proficiency
- Time Management
- Conflict Resolution
- Insurance Policy Coverage Knowledge
References
References available upon request
Certification
- State Farm Auto Certification
- All State Auto Certification
- Liberty Mutual Property Certification
- TWIA Claims Examiner Certification
- Louisiana Citizens Certification
Timeline
Total Loss Claims Adjuster (State Farm Insurance)
Crawford & Company
06.2022 - 11.2022
Claims Adjuster (State Farm Insurance)
The Best Claims Solution
01.2022 - 04.2022
Property ECTA (State Farm Insurance)
EA Renfroe
02.2021 - 12.2021
Claims Adjuster (TD Insurance)
Catastrophe Response Unit
06.2020 - 11.2020
Total Loss Claims Adjuster
Windhaven Insurance Company
09.2019 - 12.2019
Total Loss Claims Adjuster (State Farm Insurance)
The Best Claim Solution
03.2017 - 01.2019
Claims Adjuster (State Farm Insurance)
Pilot Catastrophe Services
11.2015 - 10.2016
Senior Credentialing QA Analyst
Federation of State Medical Board
01.2004 - 04.2015
Bachelor of Science (B.S.) in Computer Information Systems -
Grambling State University