Kay Crawford
Longs,SC
Summary
Seasoned claim consultant with a long record of handling property, healthcare, and liability claims. Skilled in claims investigation, policy compliance, and clear client communication. Proven ability to assess evidence, determine claim value, and negotiate fair settlements that support efficient resolution.
Overview
39
39
years of professional experience
Work History
Claim Consultant (Remote Position)
Claim Consultants, LLC
Charleston, SC
05.2025 - Current
- Managed property damage claims in line with legal rules and industry standards to protect claim integrity.
- Reviewed claims for validity and proper coverage to support accurate processing.
- Examined documents and supporting evidence to estimate claim value and likely outcome.
- Communicated claim steps clearly with clients to explain process and set expectations.
Loss Assignor
Progressive Insurance
Myrtle Beach, SC
11.2016 - 02.2022
- Assigned claims to representatives based on expertise to help reduce resolution time.
- Assigned claims to team members based on skills to enhance case resolution.
- Worked with cross-functional teams to simplify claims processing and improve workflow efficiency.
- Reviewed loss claims for validity and ensured policy compliance.
Claim Representative
State Farm Insurance
Myrtle Beach, South Carolina
03.1998 - 07.2013
- Reviewed State Farm claim files to assess coverage, liability, and loss details, ensuring accurate processing.
- Interviewed policyholders and witnesses to collect accident and damage statements.
- Clarified claim procedures and addressed coverage questions for State Farm policyholders, enhancing customer understanding.
- Coordinated with adjusters, repair shops, and medical providers on claim activity.
- Investigated facts, confirmed coverage and liability, negotiated settlements, and determined claim payments.
- Identified and reported potential fraud indicators during review process, contributing to risk management efforts.
- Attended legal proceedings tied to claims, including arbitrations and mediations.
- Negotiated settlements with claimants and attorneys to resolve claims efficiently and fairly.
Claim Processor
Cigna Healthcare
Gastonia, NC
02.1988 - 02.1998
- Processed healthcare claims following Cigna benefit guidelines and coverage policies.
- Reviewed medical codes and plan details to ensure accurate claim adjudication.
- Updated members on claim status and provided benefit information to enhance understanding.
- Responded to telephone inquiries regarding claim status about claim status and company services.
- Coordinated benefits with insurance plans and Medicare providers to streamline claim processing.
Education
Bachelor of Science - Social Science
Gardner-Webb University
Boiling Springs, NC08-1982
Skills
- Claims processing
- Claim adjudication
- Coverage analysis
- Liability assessment
- Claims investigation
- Settlement negotiation
- Policy compliance
Timeline
Claim Consultant (Remote Position)
Claim Consultants, LLC
05.2025 - Current
Loss Assignor
Progressive Insurance
11.2016 - 02.2022
Claim Representative
State Farm Insurance
03.1998 - 07.2013
Claim Processor
Cigna Healthcare
02.1988 - 02.1998
Bachelor of Science - Social Science
Gardner-Webb University