Microsoft Excel
Years of professional experience
Jessica Smith
Lakeland,FL
Summary
Experienced in injury claims examination and insurance investigations with a strong background in litigation management, settlement negotiations, and legal and medical documentation review. Deep understanding of compliance and regulatory knowledge, excelling in report writing and documentation. Expertise in case management allows for effective handling of multiple cases simultaneously. Known for analytical and critical thinking abilities to identify key issues and develop strategic solutions. Exceptional communication and interpersonal skills enable the building of strong relationships with clients, counsel, and colleagues.
Overview
20
20
5
5
Years of claims experience
Work History
MAJOR CASE INVESTIGATOR
GEICO
09.2023 - 08.2024
- Executed comprehensive evaluations on intricate and valuable first-party (PIP) medical claims, guaranteeing meticulous and precise analysis.
- Compiled data and created thorough reports to document findings.
- Collected, analyzed and interpreted information, documentation, and physical evidence associated with investigations.
- Employed questioning techniques to gather information from subjects during investigations.
- Enhanced case resolution rates through comprehensive investigations and efficient interviewing techniques.
- Developed comprehensive reports that accurately detailed investigation findings and supported legal proceedings.
- Compiled analytical data to check for fraudulent indicators including overtreatment, billing for services not rendered, boiler point treatment, etc.
SENIOR INTERNAL INVESTIGATOR
GEICO
01.2023 - 09.2023
- Investigated a wide range of insurance fraud cases, including auto, property, and health insurance claims.
- Improved case resolution rates by conducting thorough investigations and utilizing effective interviewing techniques.
- Prepared case reports from allegations, transcripts of interviews and physical evidence.
- Collect and analyze evidence from multiple sources, including documents, databases, interviews, and surveillance footage.
- Conduct interviews with witnesses, claimants, and suspects to gather information and obtain statements.
- Compile detailed investigative reports that outline findings, conclusions, and recommendations for corrective actions.
- Work with law enforcement agencies and other external organizations to support criminal investigations and legal proceedings.
- Ensure the confidentiality and security of sensitive information throughout the investigation process.
- Monitor and ensure adherence to company policies, industry regulations, and legal requirements.
- Provide training and education to employees on fraud prevention and detection techniques.
- Keep abreast of industry trends, emerging threats, and best practices in fraud investigation and prevention.
BODILY INJURY CLAIMS EXAMINER
GEICO
07.2019 - 01.2023
- Managed caseload of complex injury claims involving litigation, ensuring thorough investigation and fair resolution.
- Reviewed and analyzed legal and medical documentation to determine the validity of claims and evaluate potential settlement value.
- Served as a key collaborator with legal counsel in the development of case strategies, deposition preparation, and court proceeding support.
- Established favorable resolutions by skillfully negotiating settlements with claimants, attorneys, and third parties to reduce litigation expenses.
- Managed comprehensive documentation for case activities, correspondence, and settlement agreements.
- Achieved and maintained compliance with all legal and regulatory requirements while upholding strict standards of accuracy and integrity.
- Performed comprehensive investigations into liability and insurance coverage to evaluate risk exposure and recommend suitable coverage options.
DIRECTOR OF BUSINESS DEVELOPMENT
Florida Best Quote Insurance 2
01.2017 - 07.2019
- Enhanced company's reach by establishing satellite offices and recruiting additional insurance professionals.
- Contributed to the establishment of new offices, enhancing the professionalism experienced by agents and clients.
- Managed the development and upkeep of website and various social media accounts.
- Established comprehensive training manuals and integrated revised organizational guidelines.
- Executed payroll management alongside other administrative responsibilities.
- Presented persuasive presentations at industry conferences showcasing company expertise, generating interest from potential new clients.
- Mentored team members to develop their skills, leading to increased productivity and successful promotions within the company.
PROJECT AND OPERATIONS MANAGER
ARKON POWER
01.2014 - 01.2016
- Oversee the planning, implementation, and finalization of multiple high dollar projects.
- On-site management of project and all contractors.
- Budget project to ensure company profit.
- Organize and guide project operations throughout the course of project.
- Vet, negotiate and hire all subcontractors.
- Work directly with customers to ensure a positive experience throughout the entirety of the project.
- Bookkeeping responsibilities including A/P, A/R, P/L, 1099’s, inventory, and reporting.
- Demonstrated strong organizational and time management skills while managing multiple projects.
LICENSED INSURANCE AGENT
FLORIDA BEST QUOTE
01.2013 - 12.2014
- Calculated quotes and educated potential clients on insurance options.
- Recommended type and amount of coverage based on analysis of customers' circumstances using persuasive sales techniques.
- Leveraged knowledge of company insurance products and services to advise customers on appropriate choices.
- Established trust with clients through transparent communication regarding policy costs, coverages, exclusions, limitations, endorsements or riders available upon request.
- Delivered outstanding first-contact resolution rates when assisting clients with inquiries about premiums or billing issues.
- Attended continuing education courses and workshops to gain additional insurance industry knowledge.
- Achieved high client retention rates by consistently delivering exceptional service and support throughout the policy lifecycle.
- Prepared and reviewed insurance applications to verify compliance with regulations.
Education
Master of Arts - BUSINESS ADMINISTRATION
LSUS
08.2026
Bachelor of Science - MANAGEMENT & ORGANIZATIONAL LEADERSHIP, PROJECT MANAGEMENT
St. Petersburg College
05.2017
Certification - Accounting Technologies
St. Petersburg College
05.2017
Skills
- Detailed report writing
- Interview techniques
- Research abilities
- Ethical and honest
- Investigation Management
- Reliability
- Organizational Skills
- Excellent Communication
- Claims Processing
- Coverage Determination
- Liability Determination
- Settlement Negotiation
- Microsoft Tools
- Claims Processing
- Coverage Determination
- Liability Determination
- Settlement Negotiation
- Salesforce Experience
- TLO, Accurint and other database experience
Software
Microsoft Outlook
Microsoft Word
Microsoft Project
SICM
Accurint
TLO
DRN
Atlas
ClaimIQ
ISO
Work Preference
Work Type
Full TimeLocation Preference
RemoteHybridImportant To Me
Company CulturePersonal development programsCareer advancementHealthcare benefitsStock Options / Equity / Profit Sharing401k matchLanguages
English
Native or Bilingual
Quote
Success is not final; failure is not fatal: It is the courage to continue that counts.
Winston S. Churchill
Certification
- Licensed 6-20 Claims Adjuster
Timeline
MAJOR CASE INVESTIGATOR
GEICO
09.2023 - 08.2024
SENIOR INTERNAL INVESTIGATOR
GEICO
01.2023 - 09.2023
BODILY INJURY CLAIMS EXAMINER
GEICO
07.2019 - 01.2023
DIRECTOR OF BUSINESS DEVELOPMENT
Florida Best Quote Insurance 2
01.2017 - 07.2019
PROJECT AND OPERATIONS MANAGER
ARKON POWER
01.2014 - 01.2016
LICENSED INSURANCE AGENT
FLORIDA BEST QUOTE
01.2013 - 12.2014
Master of Arts - BUSINESS ADMINISTRATION
LSUS
Bachelor of Science - MANAGEMENT & ORGANIZATIONAL LEADERSHIP, PROJECT MANAGEMENT
St. Petersburg College
Certification - Accounting Technologies
St. Petersburg College