Kareema Arkel
Union City,GA
Summary
A motivated adjuster with goals to maintain customer satisfaction and exceed company goals. Ability to establish long term rapport with injured claimants, medical providers, and attorneys. Fostering a positive experience with high quality customer care with prompt resolutions of complaints, negotiations and claims, highly skilled with injury claims from start to end – investigating the claim, liability analysis, weekly follow ups, negotiating the claim, settling claims directly with attorneys and customers.
Overview
16
16
years of professional experience
1
1
Certification
Work History
Senior Resolution Specialist
PRG/ Gallagher and Bassett
05.2024 - 01.2025
- Worked with compliance and legal departments to handle sensitive issues and legal proceedings.
- Implemented new software tools to automate aspects of the resolution process, increasing efficiency across the team.
- Served as a subject matter expert on dispute resolution, advising colleagues on best practices and industry trends.
- Leveraged advanced problem-solving skills to address difficult or escalated cases, ensuring customer satisfaction.
- Provided exceptional customer service while managing a high volume of inquiries from clients regarding disputes or complaints.
- Assisted in developing standardized scripts for consistent communication with customers during the resolution process.
- Compiled data on trends and identified potential enhancements.
- Improved customer satisfaction by efficiently resolving complex issues and providing timely solutions.
- Negotiated settlements between disputing parties, balancing the needs of both sides while upholding company policies.
- Reviewed legal documents and contracts to determine potential conflicts and disputes.
- Used mediation techniques to facilitate communication between disputants, to further parties' understanding of different perspectives and to guide parties toward mutual agreement.
Claims Adjuster
Jones Group/Gallagher & Bassett
01.2021 - 03.2024
- Exercises proper judgment and decision making to analyze the claims exposure, to determine the proper course of action and to appropriately settle the claim
- Investigates, evaluates, disposes and settles the most complex claims and highest exposures with minimal supervision Includes the determination and evaluation of coverage, liability and damages, and the setting of proper reserves
- Interacts extensively with various parties involved in the claim process
- Able to clearly communicate concise action plans, and present plans for moving the case to conclusion
- Will demonstrate complete knowledge of the claim file process through presentation of actions and responses to client questions
- Processes claims consistent with clients' and corporate policies, procedures and 'best practices' and also in accordance with any statutory, regulatory and ethics requirements
- Demonstrated ability to comply with carrier reporting and threshold requirements
- Able to recognize and pursue excess insurance recoveries
- Incumbents will have the ability to handle a full case load, with proven ability to handle cases of increased severity
- Claims reserve and settlement authority of up to $20,000 liability and/or $50,000 workers compensation or greater
- 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.
UM/UIM/Litigation Claims Adjuster
Allstate Insurance Co.
01.2018 - 01.2021
- Investigating complex claims when an attorney is representing the injured party including - (UM/UIM) claims in single or multi car accidents; (2) Injury Casualty Soft Tissue and represented - moderate or major claims, complex Commercial Property Liability
- Documents a claim file with notes, evaluations and decision making process Coverage, Liability and Evaluation
- Determines and explains minimum coverage limits in complex claims involving single or multiple claimants
- Sets initial reserve, updates reserve, documents rationale and claim summary notes
- Obtains photos and/or conducts scene investigation
- Takes recorded statements from claimants, insureds, witnesses, medical providers, conducts investigations into complex auto accidents, determines liability and prepares summaries
- Evaluates and determines potential use of experts; reviews reports and participates in selecting the expert
- Determines claim value
- Reviews file to identify complex potential legal issues Negotiation and Settlement Guidance
- Negotiates and settles claims in accordance with business unit best practices
- Reviews medical reports in preparation for claims settlement evaluation
Claims Adjuster (Remote)
Allstate Insurance Co.
01.2013 - 01.2018
- Working independently and directly with attorneys to negotiate and settle claims
- Investigating single and multi-vehicle auto accidents to determine the at-fault party with reviewing photos and obtaining recorded statements
- Negotiate with claimants or their attorneys
- Settle claims and set reserves
- Estimate cost of treatment or compensation for those injured in accidents
- Analyze and interpret medical reports, follow up with no-fault parties, and manage claims process to ensure efficient resolution
- Interview, collect and document information from various people such as claimants, agents/brokers, attorneys, and police
- Evaluating claims reviewing medical records and bills and concluding a settlement offer directly with the patient
- Responsible for workers compensations demands, reviewing medical treatment related to the loss approving and denying certain treatment received
- Reporting claims with other carriers, responding to their request in professional and timely manner
- Managing claim recoveries of all types, subrogation demands, medical providers liens, Medicare/Medicaid liens, Med Pay / PIP offsets and child support lien offsets
- Detail oriented with strong organizational management skills, able to work well under deadlines in a changing environment and perform multiple tasks effectively and concurrently
- Maintain accurate documentation/information in claim file and claims system as per claim handling requirements including coverage analysis, proper damage and liability evaluations, proactive resolution management and settlement rationale
Claims Express
Allstate Insurance Co.
01.2009 - 01.2013
- Thoroughly analyze, investigate, negotiate and resolve claims
- Provide world class customer service to insureds, agents, brokers and underwriters
- Maintain accurate documentation/information in claim file and claims system as per claim handling requirements including coverage analysis, proper damage and liability evaluations, proactive resolution management and settlement rationale
- Identify recovery management opportunities in the earliest stages of claim development
- Retain, monitor, manage and approve payments to outside counsel actively utilizing litigation management plans and budgets
- Maintain knowledge of coverage law, legislative and industry-related initiatives and judicial trends and provide claim updates and coverage interpretation to regional underwriters
- Verify coverages for customers or verify that policy changes were made and provide proof of evidence of insurance documents to customers where coverage previously bound by a licensed producer
Education
bachelor’s degree - Business
Strayer
Certificate - Medical Coding and Billing
Erie Community College
Buffalo, NYCertification
- Adjuster's License, Florida, #FL921060Z
- Adjuster's License, Georgia, #0330000
- Microsoft Excel Lotus 123, MAS500, Sage Payments, NextGen, ISO, Mitchell, Collosus, Oracle, Main frame and Internet.
Timeline
Senior Resolution Specialist
PRG/ Gallagher and Bassett
05.2024 - 01.2025
Claims Adjuster
Jones Group/Gallagher & Bassett
01.2021 - 03.2024
UM/UIM/Litigation Claims Adjuster
Allstate Insurance Co.
01.2018 - 01.2021
Claims Adjuster (Remote)
Allstate Insurance Co.
01.2013 - 01.2018
Claims Express
Allstate Insurance Co.
01.2009 - 01.2013
Certificate - Medical Coding and Billing
Erie Community College
bachelor’s degree - Business
Strayer
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