James Matthews
Lake Elsinore,CA
Summary
Experienced claims adjuster with a strong background in confidential litigation claims. Proven expertise in investigating, evaluating, and settling a wide range of casualty claims. Skilled in identifying fraudulent activities, analyzing data, and collaborating with legal counsel to ensure accurate claim processing. Highly effective communicator actively engaging with agents and brokers to gather essential information for efficient and thorough claim resolution.
Overview
24
24
years of professional experience
1
1
Certification
Work History
Claims Adjuster
Alliance of Schools for Cooperative Insurance Programs
03.2024 - 10.2024
- Negotiated favorable settlements with claimants, attorneys, and other insurance carriers to minimize financial risk for the company.
- Examined claims forms and other records to determine insurance coverage.
- Verified insurance claims and determined fair amount for settlement.
- Maintained compliance with state regulatory requirements through meticulous documentation and adherence to company policies.
- Conducted thorough investigations of complex insurance claims, gathering evidence and analyzing relevant documentation.
Senior Claims Adjuster
CorVel Corporation
06.2016 - 03.2024
- Handled “foodborne illness,” claims
- Interview or correspond with claimant, witness, police, physicians, or other relevant parties to determine claim settlement, denial, or review
- Interviewed claimants and witnesses to gather factual information
- Synthesized data into comprehensive quarterly written reports for management
- Reviewed new files to determine current status of injury claim and to develop plan of action
Senior Claims Adjuster
Gallagher Bassett Services Inc.
11.2013 - 02.2015
- Handled complex employment practices claims
- Procured recoveries in excess of $1 million
- Conducted recorded phone statements
- Maintained 1:1 closing ratio
- Interviewed claimants and witnesses to gather factual information
- Interviewed agents and claimants to correct errors or omissions and investigate questionable claims
Claims Adjuster
Supervalu Inc. / New Albertson's Inc.
08.2005 - 12.2011
- Interview or correspond with claimants, witnesses, police, physicians, or other relevant parties to determine claim settlement, denial, or review
- Collect evidence to support contested claims in court
- Interviewed agents and claimants to correct errors or omissions and investigate questionable claims
- Examined claims forms and other records to determine insurance coverage
Claims Specialist
Broadspire / Kemper Insurance Companies
04.2001 - 07.2005
- Investigate, evaluate and settle claims, applying technical knowledge and human relations skills to effect fair and prompt disposal of cases and to contribute to a reduced loss ratio
- Adjust reserves or provide reserve recommendations to ensure that reserve activities are consistent with corporate policies
- Resolve complex, severe exposure claims, using high service oriented file handling
- Verify and analyze data used in settling claims to ensure that claims are valid and that settlements are made according to company practices and procedures
- Present cases and participate in their discussion at claim committee meetings
Education
Bachelor of Arts - Pre-Law
California State University
Fullerton, CA06.1997
Skills
- Verbal Communication
- Written Communication
Certification
- CA
- NY
- TX
- FL
- OK
- OR
- UT
Timeline
Claims Adjuster
Alliance of Schools for Cooperative Insurance Programs
03.2024 - 10.2024
Senior Claims Adjuster
CorVel Corporation
06.2016 - 03.2024
Senior Claims Adjuster
Gallagher Bassett Services Inc.
11.2013 - 02.2015
Claims Adjuster
Supervalu Inc. / New Albertson's Inc.
08.2005 - 12.2011
Claims Specialist
Broadspire / Kemper Insurance Companies
04.2001 - 07.2005
- CA
- NY
- TX
- FL
- OK
- OR
- UT
Bachelor of Arts - Pre-Law
California State University
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