JENNIFER POUGH
Ledgewood
Summary
Developed skills in fast-paced insurance environment, demonstrating expertise in data analysis and problem solving. Proven ability to manage complex claims processes with focus on customer satisfaction and efficient resolution. Seeking to leverage transferrable skills in new field, bringing high level of adaptability and proficiency in managing intricate tasks.
Overview
29
29
years of professional experience
Work History
Claim Specialist III Accident & Health Special Risk
Zurich Insurance Company
Parsippany
07.2014 - Current
- Currently handle Accidental Death & Dismemberment, Out of Country Medical, Travel Assistance, Tuition Reimbursement, Hospital Indemnity, Accident Medical Expense and Reinsurance claims
- Exercise judgment to determine policy verification and coverage determination by analyzing applicable coverage for claims and determining whether the loss falls within the coverage
- Negotiate settlement of claim by establishing appropriate negotiation strategy and utilizing available tools and resources
- Resolved complex insurance claims to provide accurate outcomes for clients.
- Processed claims documentation to ensure compliance with company policies.
- Analyzed claim details to identify fraudulent activities, maintaining integrity of processes.
- Coordinated with underwriters to streamline claim settlements.
- Provided detailed explanations of coverage policies to clients, enhancing understanding.
- Communicated effectively with stakeholders to address claim-related concerns.
- Conducted thorough investigations into insurance claims to determine coverage eligibility and appropriate compensation amounts.
- Provided exceptional customer service during difficult situations, displaying empathy while explaining complex claim issues clearly to clients.
- Managed high-volume caseloads effectively, prioritizing urgent cases while maintaining attention to detail for all claims.
- Assist Underwriting with Onboarding of new accounts.
- Mitigated company risk by identifying fraudulent activities and implementing preventative measures.
- Coordinated with medical professionals to obtain necessary documentation for evaluating injury claims accurately.
- Mentored new hires during their onboarding process, sharing insights from years of experience as a Senior Claims Examiner.
Claim Specialist III Accident & Health Special Risks
Zurich Insurance Company
Parsippany
01.2006 - 06.2014
- Documented claims file by accurately capturing and updating claims data/information in compliance with best practices for single and multi-party personal or commercial line claims of moderate to high exposure and complexity.
- Exercised judgment to determine liability by gathering and analyzing relevant facts; utilizing applicable law; establishing basic principles of negligence.
- Exercised judgment to determine policy verification and coverage determination by analyzing applicable coverage for claims and determining whether the loss falls within the coverage.
- Worked to have a timely resolution to claims by developing case strategy; developing a case evaluation; escalating issues as appropriate.
- Established timely reserves and performed ongoing review throughout claims cycle within authority limit by estimating and validating value of claims.
- Assessed damages by calculating applicable damages or range of damages allowed by law.
- Negotiated settlement of claim by establishing appropriate negotiation strategy and utilizing available tools and resources.
Senior NY No Fault Examiner- New York Claims
Clarendon National Insurance
Saddle Brook
10.2002 - 01.2006
Licensed NY Senior Claim Examiner
Cambridge Integrated Services
Whippany
02.2001 - 10.2002
Senior NY Claim Examiner, Commercial Claims
Hertz Claim Management
Park Ridge
03.2000 - 02.2001
Senior Claim Examiner
Liberty Mutual
Saddle Brook
11.1996 - 03.2000
Education
A.A.S. - Business Administration
Berkeley College
West Paterson, New Jersey01.1998
Skills
- Communication
- Time management
- Research skills
- Data analysis
- Teamwork
- Adaptability
- Critical thinking
- Customer service
- Time management
- Research skills
Timeline
Claim Specialist III Accident & Health Special Risk
Zurich Insurance Company
07.2014 - Current
Claim Specialist III Accident & Health Special Risks
Zurich Insurance Company
01.2006 - 06.2014
Senior NY No Fault Examiner- New York Claims
Clarendon National Insurance
10.2002 - 01.2006
Licensed NY Senior Claim Examiner
Cambridge Integrated Services
02.2001 - 10.2002
Senior NY Claim Examiner, Commercial Claims
Hertz Claim Management
03.2000 - 02.2001
Senior Claim Examiner
Liberty Mutual
11.1996 - 03.2000
A.A.S. - Business Administration
Berkeley College
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