Summary
Overview
Work History
Education
Skills
Timeline
Generic

JANELLE JACKSON

Fort Worth

Summary

Property adjustment professional equipped with comprehensive experience in claim assessments and resolutions. Consistently delivers accurate evaluations and fosters positive relationships with clients and team members. Known for reliability, adaptability, and collaborative approach to achieving results.

Overview

19
19
years of professional experience

Work History

SENIOR PROPERTY ADJUSTER

OPENLY INSURANCE
07.2023 - 02.2025
  • Investigated claims by reviewing policy contracts determine claim coverage based on cause and facts of loss.
  • Carefully reviewed claim information to verify accuracy and avert fraudulent claims.
  • Developed and maintained working relationships with independent adjusters and contractors to assist in prompt claim handling.
  • Estimates water damage in a dwelling, hail damage, and smoke or fire damage.
  • Handles ALE (additional living expense) claims as needed.
  • Communicates empathetically with customers and helped them through their claim process.
  • Negotiates claim settlements with customers in accordance with business unit standard methodologies.
  • Makes recommendations to management for settlement amounts outside of authority limits. Closes claim files upon completion of final payment.
  • Alerts underwriting, marketing and/or risk management regarding questionable risks encountered to ensure potential hazards are clearly documented
  • Directed claims negotiations within allowable limit of $75,000 and supported successful litigations for advanced issues
  • Investigated claims by reviewing policy contracts to determine claim coverage based on cause and facts of loss.
  • Used Symbility to compile estimates for personal property and structure damage.
  • Developed and maintained working relationships with independent adjusters and contractors to assist in prompt claims handling.
  • Developed effective techniques to mitigate losses.
  • Coordinated and managed field investigations, outside engineers, contractors and cause and origin experts.
  • Demonstrated adaptability in handling a diverse range of property claims, from minor damage incidents to total loss situations.
  • Expedited claim processing times through diligent file management, including thorough documentation of claim notes, photographs, and correspondence.
  • Provided exceptional customer service while navigating sensitive situations involving property loss or destruction due to natural disasters or accidents.
  • Examined claims forms and other records to determine insurance coverage.
  • Reviewed police reports, medical treatment records, and physical property damage to determine extent of liability.
  • Assisted homeowners by coordinating vendor services, emergency repair, cleaning and contractors.
  • Achieved timely resolution of property claims by investigating, evaluating, and settling a variety of cases.
  • Enhanced customer satisfaction with prompt communication and consistent follow-up on claim status updates.
  • Exercised proper judgment and decision making to analyze over 15 claims per week.


CAT INSIDE RESOLUTION SPECIALIST II PROPERTY

LIBERTY MUTUAL
12.2021 - 05.2023
  • Investigates claim damages and situation using internal and external resources. Investigation steps include speaking with the insured or other involved parties such as contractors, requesting and receiving a field investigation report, research on past claim activity, research on external websites for CAT event confirmation, and engaging vendors for services, material supply and/or pricing.
  • Determines policy coverage through analyzing investigation data and policy terms, including whether claim will be approved or denied. Notifies insured of coverage or any issues. Establishes reserve levels at the beginning of handling a claim and adjusts as appropriate based on investigation findings.
  • Handles and owns claims submitted by independent adjusters, including making coverage and reserve decisions, and reviewing work for accuracy.
  • Maintains accurate and current communication with insured/claimant.
  • Maintains accurate and current claim file documentation throughout the life cycle of claim cases.
  • Engages specialized departments such as Special Investigation Unit and Subrogation as appropriate.
  • Determines and negotiates settlement amounts for damages claimed within assigned authority limits. Makes recommendations to management for settlement amounts outside of authority limits. Closes claim files upon completion of final payment.
  • Alerts underwriting, marketing and/or risk management regarding questionable risks encountered to ensure potential hazards are clearly documented.
  • May participate in Field CAT unit activities as appropriate to expedite claims processing.
  • May participate in conducting suit committees, roundtables, arbitrations, and mediations.
  • Updates and maintains various systems with claims data on claim status, reserves, etc. once information is received by Field CAT Claims Specialists on property claims.
  • Reviews recommendations for causation, approval / denial made by Independent Adjusters to determine whether to approve / deny the claim. Approves recommendations for reserve and settlement/payment schedule amounts.
  • Performs other duties as assigned.
  • Implemented effective communication skills to deescalate high-tension situations, fostering positive relationships between customers and the company.

CATASTROPHE INSIDE PROPERTY ADJUSTER II

ALLSTATE
11.2017 - 11.2021
  • Make and maintain connection with customers by understanding and meeting their needs during catastrophic events.
  • Uses high resolution photographs provided by virtual imagery and uses advanced video technology to collaborate with onsite vendors to identify damages and write a damage estimate from a virtual setting.
  • Conducts detailed review of property and write an estimate to capture the extend of the damages.
  • Reviews the policy and decides how coverage applies and provided the customer with a detailed explanation of both the estimate and the policy.
  • Communicates empathetically with customers and helped them through their claim process in a fast, fair, and easy manner.
  • Negotiates claim settlements with customers in accordance with business unit standard methodologies.
  • Investigates, reviews, determines, and verifies basic and occasionally moderately complex coverage/policy information.
  • Provides coverage information to the customer.
  • Reviews, evaluates, and submits potential underwriting referral actions.
  • Review/approve basic and occasionally moderately complex repair estimate.
  • Prepares basic and occasionally moderately complex damage estimates.
  • Organizes and reconciles bills.
  • Conducts fast track estimating.
  • Handles ALE (additional living expense) claims as needed.
  • Handles contents inventory and basic and occasionally moderately complex pricing analysis and prepare claims reports.
  • Estimates water damage in a dwelling, hail damage, and smoke or fire damage.
  • Negotiation and settlement guidance
  • Team Lead in Catastrophe Response Team deployments (CRT) for Hurricanes Dorian, Florence, Michael, Laura and the Houston explosion.
  • Mentor for adjusters that have completed training by allowing them to do virtual sits, listen to calls and answer questions regarding polices, estimating and documentation.
  • Improved claim resolution times by efficiently managing a caseload of property claims and conducting thorough investigations.
  • Settled claims after determining clients coverages, liability and authority levels.
  • Negotiated favorable settlements with policyholders by employing effective communication skills and deep understanding of policy provisions.
  • Maintained organized case files throughout the adjustment process, enabling seamless handoffs between involved parties and promoting efficient claim resolution.
  • Examined claim forms, policies and endorsements and client instructions to determine coverages.
  • Mitigated losses through timely on-site inspections, ensuring accurate damage assessments were conducted in accordance with company guidelines.
  • Increased efficiency by effectively utilizing claims management software tools to track progress and monitor workload distribution.
  • Carefully reviewed claim information to verify accuracy and avert fraudulent claims.
  • Used Xactimate to compile estimates for personal property and structure damage.

INSIDE LIABILITY ADJUSTER

ALLSTATE
02.2014 - 11.2017
  • Makes and maintains a connection with the customer by understanding and meeting their needs; serves the customer with empathy; and follows up to ensure that customer needs have been met.
  • Summarizes documents and enters claim system notes.
  • Documents a claim file with notes, evaluations, and decision-making process.
  • Determines applicable coverages in basic claims involving a single claimant and determines applicable coverage limits in basic claims involving multiple claimants.
  • Takes recorded statements from claimants, insureds, witnesses, etc. and prepares summaries.
  • Conducts investigations into minor single and multi-car accidents to obtain additional claims and coverage information and assist in determining liability.
  • Reviews investigation notes and determines claim value, coverage, and liability for basic claims.
  • Negotiates and settles claims in accordance with business unit best practices.
  • Provides a professional claim handling experience.
  • Negotiated fair settlements with claimants, ensuring both parties reached a satisfactory agreement.
  • Assisted policyholders in understanding coverage options, helping them make informed decisions about their insurance needs.

Benefits CLAIMS SPECIALIST

AETNA
07.2012 - 02.2014
  • Process paper claims and electronic work queues, including complex HCFA 1500 and UB04
  • Interpret and process adjustments and review basic pended claims to determine the appropriateness of the claim status and takes necessary action based on status.
  • Examine information including authorizations, payments, denials, coordination of benefits, eligibility and resolve outstanding issues to achieve customer satisfaction goals.
  • Responsible for claim data corrections on computer interactions and maintain production levels and quality goals.
  • Check claims for details such as eligibility, diagnosis, procedure coding, co-payments, etc.

QUALITY SPECIALIST II

CITI MORTGAGE
09.2011 - 07.2012
  • Reviews department activities to ensure that all processes, procedures and policies are followed.
  • Scores random samples of multiple job functions utilizing appropriate quality monitoring systems.
  • Performed side-by-side and procedure evaluations with staff to identify process improvements.
  • Facilitates and participates in calibration calls between quality staff and operations management teams to ensure consistency in quality and scoring.
  • Applied policies, procedures, and guidelines to help identify process improvements.
  • Works with limited supervision while performing job duties.
  • Responsible for handling the on-hold and off-hold foreclosure process.
  • Knowledge of 2MP process.

ACCOUNT MANAGER II

Bank of America
12.2005 - 05.2011
  • Answering mortgagors and/or third-party inquiries regarding real-estate loans in an inbound/outbound high-volume call-center.
  • Finding solutions for customers, who are encountering temporary financial difficulties.
  • Resolving customer issues by identifying reasons for default and establishing promises to pay.
  • Collecting mortgage payments, outstanding fees, and corporate advances.
  • Providing reinstatement quotes and releasing payoff statements.
  • Review customers’ financial statements to determine customers’ candidacy for loan modifications and/or repayment plans.
  • Responsible for submitting recommendations to the workout team for customers who meet the qualifications for loan modifications and /or repayment plans.
  • Responsible for resolving escalated issues.
  • Understands and educates frontline associates on account terms and systems and conducts side by side training for continual development and coaching needs.
  • Navigates a computerized data entry system or other relevant applications.
  • Responsible for statistical reporting and for undertaking audits ensuring compliance with control procedures.
  • Supervised frontline associates for an eighteen-month period.
  • Knowledge of foreclosure claims process.
  • Responsible for auditing accounts and making necessary corrections.
  • Responsible for handling on-hold/off-hold foreclosure accounts.
  • Responsible for handling accounts that are in bankruptcy and litigation.

Education

Bachelor of General Studies -

Southern University at New Orleans
New Orleans, Louisiana
05.2005

High School Diploma - undefined

McDonogh No. 35 High School
New Orleans, Louisiana
05.1996

Skills

  • Excellent communication, comprehension, listening and negotiating skills
  • Effective analytical and interpretive skills
  • Ability to multitask and problem-solve in a high-volume production-oriented environment
  • Ability to handle heavy phone activity accurately and expediently
  • Ability to maintain production levels and quality goals
  • Demonstrates ability to work in a fast-paced environment
  • Demonstrates responsiveness and a sense of urgency when dealing with customers
  • Excellent organizational aptitude and high attention to details
  • Excellent customer relation skills
  • Supervisory skills set
  • Knowledge of medical terminology and medical coding
  • Knowledge of claim policies, procedures, claim systems, coverage damage estimating and/or settlement and adherence to applicable legal compliance standards
  • Experience with Medicare and Medicaid eligibility
  • Microsoft Office; Microsoft Excel; Microsoft Word; Microsoft Outlook; PowerPoint; Mainframe; Xactimate; Symbility
  • Typing: 50 wpm
  • Estimating repair costs
  • Damage assessment
  • Property inspection
  • Problem-solving
  • Insurance policy knowledge
  • Time management
  • Attention to detail
  • Critical thinking
  • Excellent communication
  • Organizational skills
  • Customer service and support
  • Claims
  • Decision-making
  • Active listening
  • Claims adjustment

Timeline

SENIOR PROPERTY ADJUSTER

OPENLY INSURANCE
07.2023 - 02.2025

CAT INSIDE RESOLUTION SPECIALIST II PROPERTY

LIBERTY MUTUAL
12.2021 - 05.2023

CATASTROPHE INSIDE PROPERTY ADJUSTER II

ALLSTATE
11.2017 - 11.2021

INSIDE LIABILITY ADJUSTER

ALLSTATE
02.2014 - 11.2017

Benefits CLAIMS SPECIALIST

AETNA
07.2012 - 02.2014

QUALITY SPECIALIST II

CITI MORTGAGE
09.2011 - 07.2012

ACCOUNT MANAGER II

Bank of America
12.2005 - 05.2011

High School Diploma - undefined

McDonogh No. 35 High School

Bachelor of General Studies -

Southern University at New Orleans

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