Kashana Pinckney
Claims Technical Auditor and Oversight Manager
Loganville,GA
Summary
I am a focused and dedicated insurance professional with over 22 years of insurance claims experience. A driven individual and highly trained in multiple areas of commercial lines and personal lines insurance claims. In my current position as a Claims Oversight Manager and a Claims Technical Auditor, I provide oversight direction to adjusters and managers on Commercial Property and Casualty claims, identify and address coverage issues, monitor and direct coverage council and defense council involving complex losses. I lead and participate in the timely completion of audit reviews, manage special projects, finalize reports, present results to internal management and TPA management. I am a self-starter, committed to continuous learning and staying current with industry regulations to contribute to organizational success.
Overview
14
14
years of professional experience
Work History
TPA Claims Oversight Manager
Starr Insurance Company
Atlanta, GA
05.2022 - Current
- Oversee GL and Business Auto Liability claims handled by TPA.
- Review and approve reserve requests from TPA adjusters.
- Afford settlement authority to TPA and Defense Counsel
- Impart direction to TPA adjusters, Coverage Council and Defense Council.
- Review requests to overturn denials and approve or deny as appropriate.
- Undertake calls with account manager to discuss all issues related to TPA claims handling.
- Develop claim resolution strategies and plans of action with TPA adjusters.
- Hold TPA accountable to standards regarding claim handling, litigation management, settlement and closure.
Claims Technical Auditor
Starr Insurance Company
Atlanta, GA
05.2021 - Current
- Ensured timely completion of all assigned tasks within set deadlines.
- Collaborated closely with other team members to develop effective audit plans.
- Managed completion of planned audits, reviewed records and procedures for accuracy to accomplish objectives and appraised policies and plans under audit review.
- Drafted reports summarizing audit results while highlighting any irregularities or inconsistencies found during the process.
- Assisted in preparing audit plans based on established objectives and standards.
- Participated and lead special projects.
- Worked closely with management to discuss external audit results and action plans.
- Present findings to upper management and TPA management.
Claims Examiner-Liability, Account- Everest Insurance Company
Sedgwick Claims Management Services, Inc.
Dunwoody, GA
02.2018 - 05.2021
- Analyzes and processes complex or technically difficult general liability claims by investigating and gathering information to determine the exposure on the claim; manages claims through well-developed action plans to an appropriate and timely resolution..
- Assesses liability and resolves claims within evaluation.
- Negotiates settlement of claims within designated authority.
- Calculates and assigns timely and appropriate reserves to claims; manages reserve adequacy throughout the life of the claim.
- Calculates and pays benefits due; approves and makes timely claim payments and adjustments; and settles claims within designated authority level.
- Prepares necessary state fillings within statutory limits.
- Manages the litigation process; ensures timely and cost effective claims resolution.
- Coordinates vendor referrals for additional investigation and/or litigation management.
- Uses appropriate cost containment techniques including strategic vendor partnerships to reduce overall cost of claims for our clients.
- Manages claim recoveries, including but not limited to: subrogation, Second Injury Fund excess recoveries and Social Security and Medicare offsets.
- Reports claims to the excess carrier; responds to requests of directions in a professional and timely manner.
- Communicates claim activity and processing with the claimant and the client; maintains professional client relationships.
- Ensures claim files are properly documented and claims coding is correct.
- Refers cases as appropriate to supervisor and management.
- De-escalated problematic customer concerns, maintaining calm, friendly demeanor.
- Fielded customer complaints and queries, fast-tracking them for problem resolution.
- Upheld quality control policies and procedures to increase customer satisfaction.
- Asked probing questions to determine service needs and accurately input information into electronic systems.
- Made outbound calls to obtain account information.
- Answered inbound calls, chats and emails to facilitate customer service.
- Answered customer questions and addressed concerns resulting in reduction in customer complaints.
- Trained new employees on procedures and policies to maximize team performance.
Claims Examiner- Liability, Account- The Coca-Cola Company
Sedgwick Claims Management Services, Inc.
Atlanta, GA
05.2016 - 02.2018
- Negotiate with plaintiff attorneys and non-represented claimants toward settlement of non-litigation claims involving injuries, property damage and coverage disputes.
- Follows established policies, procedures, and processes in preparing information, and submits reports and documents in a timely manner and in accordance with the client's standards and expectations.
- Investigate and settle multiple liability claims as the excess carrier.
- Attend mediations and trials for property damage and bodily injury claims.
- Direct and monitor defense attorney activities on litigation claims to their conclusion.
- Investigate and successfully argue arbitration files resulting in recovered funds for the company based upon defense of accurate liability assessments.
- Monitor Defense cost
- Investigate and handle to settlement conclusion general liability, bodily injury and property damage commercial liability claims.
- Review claims and claim status with client and broker as necessary to facilitate the prompt, accurate resolution of claims filed
- Identify and pursue opportunities to accept or decline tender claims from third parties.
- Prepare and present quarterly claim review with client.
Liability Claims Adjuster- Bodily Injury, Auto and Property Damage
American Claims Management/Brown and Brown Insurance
Alpharetta, GA
04.2015 - 05.2016
- Reduced loss ratios through fair and prompt processing of claims.
- Obtained relevant evidence and information regarding suspicious claims.
- Closed an average of 130-160 cases per quarter.
- Contacted injured parties and legal representatives to negotiate final settlements for claims.
- Investigated claims and determined losses.
- Recommended punitive action on fraudulent claims.
Commercial Liability Claims Adjuster- Bodily Injury, Auto and Property Damage
Engle Martin and Associates
Atlanta, GA
03.2011 - 03.2015
- Drafted statement of loss to summarize damages, payments and underlying policy coverage.
- Obtained all necessary information to complete proper evaluation of injury claims.
- Recommended settlement offers and negotiated payment arrangements.
- Established contact and maintained effective professional relationships with insured parties, agents, brokers, public adjusters, attorneys, and others involved in the claims process.
- Reviewed claims and claim status with clients and brokers as necessary to facilitate the prompt, accurate resolution of claims filed
- Determined coverage and identifies coverage issues related to various claims( including injuries, property damage, fatalities, inland marine and general liability ), applying a thorough understanding of applicable insurance policies and relevant coverage and loss types.
- Negotiated with plaintiff attorneys and non-represented claimants toward settlement of non-litigation claims involving injuries, property damage and coverage disputes.
- Maintained accurate, thorough field notes, journal entries, and time and expense records as required.
- Created loss reporting documents, bodily injury packages and releases that were used by all claims professionals at EMCAS/Engle Martin and Associates.
- Assisted Management Staff with interviewing potential candidates for management and adjuster positions.
- Identified and pursued opportunities to tender claims to other at-fault parties.
- Investigated and settled general liability and inland marine claims to conclusion.
- Handled claims for clients with up to $250,000.00 in self insured retentions.
- Investigated and settled first party commercial property damage claims.
Liability Claims Adjuster-Bodily Injury, Auto and Property Damage
Drivers Insurance Company
Duluth, GA
06.2010 - 03.2011
- Interviewed claimants, medical specialists and employers to determine pertinent claim information.
- Contacted injured parties and legal representatives to negotiate final settlements for claims.
- Obtained all necessary information to complete proper evaluation of injury claims.
- Recommended settlement offers and negotiated payment arrangements.
Education
Bachelor of Arts - Science
College of Charleston
Skills
- Active Property and Casualty Insurance Licenses in AK, AL, AR, AZ CT, DE, FL, GA, HI, ID, IN, KY, LA, ME, MI, MN, MS, NH, NV, OK, OR, RI, SC, NY, TX and WA
- Knowledge of casualty claim law and jurisdictional issues in multiple states
- Skilled negotiator will
- Excellent communication skills
- An enthusiasm for leading
- Organized and Self-motivated
- Insurance fraud expertise
- Coverage Investigation experience involving multiple policies and excess carriers
- Heavily skilled in bodily injury and property damage personal liability and commercial liability losses (Including product liability, inland marine and general liability)
- Natural leader
- Complex problem solver
- Skilled in preparing and presenting concise reports to upper management
- Experienced in alternate resolutions such as Mediations and Arbitrations
- Heavily skilled in handling bodily injury and property damage commercial liability losses including inland marine and general liability
- Experienced in litigation management
- Experienced in fatalities and severe injuries
- Catastrophic Event claims experience
- Experienced in structured claim settlements
- Team Leadership
- Policy Implementation
- Performance Management
- Data Analysis
- Reserves Recommendations
- Proactive and Focused
- Expert in Risk Management
- Internal Controls and Reporting Systems
- Expert in maintaining client relationships
- Cross-Functional Team Management
- Complex Problem-Solving
- Expert in Risk Transfer
- Risk Mitigation Strategies
- Process Evaluation
- Compliance Standards
- Report Creation
- Contract Compliance
- Regulatory Compliance Adherence
- Attention to Detail
Work Preference
Work Type
Full TimeWork Location
HybridRemoteImportant To Me
Career advancementWork-life balanceCompany CultureFlexible work hoursPersonal development programsHealthcare benefitsWork from home optionPaid time offPaid sick leave401k matchStock Options / Equity / Profit SharingTimeline
TPA Claims Oversight Manager
Starr Insurance Company
05.2022 - Current
Claims Technical Auditor
Starr Insurance Company
05.2021 - Current
Claims Examiner-Liability, Account- Everest Insurance Company
Sedgwick Claims Management Services, Inc.
02.2018 - 05.2021
Claims Examiner- Liability, Account- The Coca-Cola Company
Sedgwick Claims Management Services, Inc.
05.2016 - 02.2018
Liability Claims Adjuster- Bodily Injury, Auto and Property Damage
American Claims Management/Brown and Brown Insurance
04.2015 - 05.2016
Commercial Liability Claims Adjuster- Bodily Injury, Auto and Property Damage
Engle Martin and Associates
03.2011 - 03.2015
Liability Claims Adjuster-Bodily Injury, Auto and Property Damage
Drivers Insurance Company
06.2010 - 03.2011
Bachelor of Arts - Science
College of Charleston
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