Janiffer Puricelli
P. Pines,FL
Summary
Details-focused leader with All Lines Claim Adjuster License eager to offer dynamic insurance experience gained from cross-functional background toward maximizing your bottom line in a growth-oriented role.
Overview
21
21
years of professional experience
Work History
PIP Claims Adjuster
UNITED AUTOMOBILE INSURANCE COMPANY
01.2002
- Played a vital role in reviewing claims to confirm coverage, including investigating claims for possible staging
- Reviewed medical bills for proper CPT codes and charges following Florida Statutes, along with cost-effectively negotiating medical bills with provider to lower severity on PlP and processing various payments
- Optimized administrative efficiency by maintaining a diary log for claim files and reviewing mail for Bl demand
- Evaluated and concluded claims per organizational standards and key Department of Insurance regulations.
Liability Claims Supervisor
Generali Insurance US Branch
10.2022 - Current
- Supervises claims staff in their day-to-day operations
- Supports Claims Manager in staff recruitment, interviews and training of new staff on procedures and job-related functions
- Assures peak performance of the team through continued training and coaching, coupled with regular performance evaluations and recommends merit activity, subject to manager’s approval
- Provides technical and jurisdictional guidance to claims staff regarding complex Auto and GL exposures, investigation, litigation issues and Special Handling Instructions
- Functions as liaison, suggesting and implementing final resolution for clients and employees regarding claim-specific, procedural or special requests
- Complete Daily Assignments to adjusters
- Adheres to HIPPA regulations, policies, and procedures
- Requires regular and consistent attendance
- Comply with all safety rules and regulations during work hours in conjunction with the Injury and Illness Prevention Program (IIPP)
- Adheres to all company policies, best practices and procedures
- Additional projects and duties as assigned.
Senior General Liability Adjuster
Generali Insurance US Branch
12.2020 - 10.2022
- Adjust auto claims in the pre-litigation or early litigation stages, primarily third-party automobile claims
- Favorably negotiate and settle attorney represented claims expeditiously
- Identify coverage issues based on a thorough knowledge of the policy and applicable laws/regulations
- Responsible for an inventory of legal files
- Identify high priority cases and keep on a close diary
- Draft coverage position letters or correspondence as needed
- Control claim costs and expenses to the extent possible
- Work with Legal and Claim Departments to effectively determine liability and appropriate settlements
- Identify process improvements to increase efficiency
- Assist in responding to attorney, regulatory, producer and consumer inquiries.
Commercial Bodily Injury Adjuster
Granada Insurance Company
04.2019 - 12.2020
- Adjust auto claims in the pre-litigation or early litigation stages, primarily third-party automobile claims
- Favorably negotiate and settle attorney represented claims expeditiously
- Identify coverage issues based on a thorough knowledge of the policy and applicable laws/regulations
- Responsible for an inventory of legal files
- Identify high priority cases and keep on a close diary
- Draft coverage position letters or correspondence as needed
- Control claim costs and expenses to the extent possible
- Work with Legal and Claim Departments to effectively determine liability and appropriate settlements
- Identify process improvements to increase efficiency
- Assist in responding to attorney, regulatory, producer and consumer inquiries.
Case Manager/ Legal Asst.
VG Law Group
05.2018 - 04.2019
- Manages mid-level general liability claims by gathering information to determine liability exposure; Approves and processes assigned claims, determines benefits due, and manages action plan pursuant to the claim or client contract
- Communicates claim action with client
- Ensures claim files are properly documented
- Prepare Demands PIP/ Bl
- Prepare initial discovery, i.e., interrogatories, request for production, request for admissions
- E-filing experience
- Assist with obtain medical liens from private insurance carrier & CMS.
Claims Adjuster - Bl/ GL Liability
Sedgwick_Claims_Management Services, Inc.
- 04.2018
- Manages mid-level general liability claims by gathering information to determine liability exposure; assigns reserve values to claims, making claims payments as necessary, and settling claims up to designated authority level
- Approves and processes assigned claims, determines benefits due, and manages action plan pursuant to the claim or client contract
- Manages subrogation of claims and negotiates settlements
- Communicates claim action with claimant and client
- Ensures claim files are properly documented and claims coding is correct
- Process complex lifetime medical and/or defined period medical claims which include state and physician filings and decisions on appropriate treatments recommended by utilization review
- Maintains professional client relationships
- Confer with legal counsel on claims requiring litigation.
GL Adjuster -(Temp)
Broward Health-Risk Management Dept.
04.2015 - 04.2016
- Performs initial evaluation of submitted claims and settles the claim based on pre-existing criteria determined in the class action settlement to determine settlement amount for each class member claimant
- Evaluation of the claims based on an algorithmic formula and utilizing available information for settlement purposes including obtaining executed settlement documents
- Maintains complete and organized claims files related to the class action claimants
- Works with Risk Management Technician as necessary to maintain claims database
- Prepares closed claim reports to the State
- Assists with CMS reporting for closed claims including MSMRP.
Bl Adjuster
UAIC
04.2014 - 01.2015
- 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
- Contact or interview claimants, doctors, medical specialists, or witnesses to get additional information
- Consult police and hospital records to determine extent of liability
- Search database to obtain background information on claimants and witnesses such as criminal records, past claims history, prior attempts at insurance fraud, etc
- 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 as well as respond to demands in a timely manner
- Confer with legal counsel on claims requiring litigation
- Negotiate claims settlement and recommend litigation when settlements cannot be negotiated
- Adjust reserves or provide reserve recommendations to ensure that reserve activities are consistent with corporate policies.
PIP Claims Adjuster
Kingsway Amigo
01.2003 - 01.2013
- Played a vital role in reviewing claims to confirm coverage, including investigating claims for possible staging
- Reviewed medical bills for proper CPT codes and charges following Florida Statutes, along with cost-effectively negotiating medical bills with provider to lower severity on PlP and processing various payments
- Optimized administrative efficiency by maintaining a diary log for claim files and reviewing mail for Bl demand
- Evaluated and concluded claims per organizational standards and key Department of Insurance regulations.
Education
Skills
- Claims Investigation
- Highly motivated
- Claims Processing
- Advanced oral and written communication skills
Timeline
Liability Claims Supervisor
Generali Insurance US Branch
10.2022 - Current
Senior General Liability Adjuster
Generali Insurance US Branch
12.2020 - 10.2022
Commercial Bodily Injury Adjuster
Granada Insurance Company
04.2019 - 12.2020
Case Manager/ Legal Asst.
VG Law Group
05.2018 - 04.2019
GL Adjuster -(Temp)
Broward Health-Risk Management Dept.
04.2015 - 04.2016
Bl Adjuster
UAIC
04.2014 - 01.2015
PIP Claims Adjuster
Kingsway Amigo
01.2003 - 01.2013
PIP Claims Adjuster
UNITED AUTOMOBILE INSURANCE COMPANY
01.2002
Claims Adjuster - Bl/ GL Liability
Sedgwick_Claims_Management Services, Inc.
- 04.2018