Keandra Thompson-Jones
Insurance Claim Adjuster
Dallas,TX
Summary
Claims adjuster with a well diverse background within the claims adjusting field. Throughout my career I’ve had the ability of adjusting workers compensation and automobile liability claims. My claims experience includes personal lines and commercial auto liability, Environmental, transportation, and hospitality workers compensation compensable losses. I am very precise with jurisdictional policy interpretation, coverage determination, determining liability, securing information, arranging medical evaluations, and negotiation of claim settlements using carrier and claims best practices, policies and procedures. Claims Knowledge & Expertise Workers Compensation Restaurant, Warehouse, & Heavy Equipment Workers Compensation Environmental & Transportation Segment Property Damage /Total Loss Evaluation Workers Compensation Loss Time (LT) Litigation Specialist / Litigation TL Auto Liability & Injury Evaluation Catastrophic Claim Handling Subrogation Claim Exposure
Overview
14
14
years of professional experience
1
1
Certification
Work History
PIPMPC Claims Adjuster Specialized Team
Statefarm Insurance
Dallas, TX
05.2022 - Current
- Answered customer questions regarding deductibles.
- Prepared summaries of injuries, payments and policy coverage.
- Examined claims forms and other records to determine insurance coverage.
- Verified insurance claims and determined fair amount for settlement.
- Investigate potential fraud or medical management for injuries/providers
- Assist injured first party with replacement services/attendant care
- Review matter for settlement or potential trial with the assistance on the defense legal counsel
- Monitor treatment to meet maximum medical injuries to improve first party to where they were prior to the accident.
- Utilized external sources such as but not limited to IME, UR, forensic accountant, and surveillance to complete investigation process
- Handle multiple claims at a time.
- Review medical records/report
- Manage bills up to the policy limts
Express ECTA Adjuster
The Best Claims Solutions
Irving, TX
06.2021 - 04.2022
- State Farm Auto Total Loss.
- Establishing liability with first and third party.
- Assisting with initiating Subrogation.
- Assisting with initiating Arbitration.
- Attention to detail for potential fraud.
- Excellent communication skills/documentation.
- Set up rental and tow through vendors.
- Claim handling with state jurisdiction that apply.
SR
The Hartford Insurance Co. Remote, Workers Compensation LT & MED Only
05.2014 - 05.2021
- Commercial Transportation, Waste and Hazardous Chemicals assigned segment.
- Responsible for establishing reserves, evaluating policy coverage, maintaining contact with insureds, claimants, attorneys, and medical staff to determine compensability stemming from OTJ (on the job) matters under carrier workers compensation practices, policies and procedures.
- Strong knowledge of state law jurisdictional policy interpretation(s), coverage delegations and resolving compensability issues.
- Investigated claims to determine compensability and demonstrate proper claim handling within authority.
- Provided temporary disability payments and monitored cases for continuation of benefits.
- Actively coordinated medical reviews while determining loss time wages and expected return to work dates for injured employees and benefit ending dates.
- Liaised with healthcare providers to request and review medical treatment notes while managing accounts of injured employee claim files through conclusion.
- Responsible for directing a need for surveillance, engaging IME / CME (Peer Reviews), and SIU investigators pertaining to complex medical injuries and targeted MMI.
- Precise individual with evaluating claims for potential fraud loss.
- Identified areas of possible subrogation and initiated mitigation duties in order to reduce carrier’s loss.
- Participated in multiple mediations, depositions, and hearings.
- Initiated and reviewed ISO reporting, Lexis/Nexis and NICB Systems for claim readiness.
SR. Commercial Liability Adjuster
Gallagher Bassett Insurance
Dallas, TX
02.2008 - 04.2014
- Professional Transportation and Semi-Trucking assigned segment.
- Investigated claims to determine liability and demonstrate proper claim handling within authority.
- Strong knowledge of state law jurisdictional policy interpretation(s), determining liability coverage and monitoring damage repairs.
- Responsible for establishing reserves, evaluating policy coverage, maintaining contact with insureds, claimants, and attorneys to determine loss factors stemming from transit, under carrier practices, policies and procedures.
- Conducted recorded statements to assist with a determination of carriers’ liability and potential excess exposures.
- Identified areas of possible subrogation and initiated mitigation duties in order to reduce carrier’s loss.
- Precise individual with evaluating claims for potential fraud loss.
- Participated in multiple mediations, depositions, and hearings.
- Initiated and reviewed ISO reporting, Lexis/Nexis and NICB Systems for claim readiness.
- Liaised with healthcare providers to request and review medical treatment notes while managing accounts of claimant claim files through conclusion.
- Responsible for directing a need for surveillance, engaging IME / CME (Peer Reviews), and SIU investigators pertaining to complex medical injuries and targeted MMI evaluations.
Education
Xactimate II certified -
Titanium Licensing Adjusting
Dallas, TX03.2020
B.S. Registered Nurse - Nursing
University of Arlington
Arlington, Tx06.2024
Associate of Arts -
Tarrant County College District
Arlington, Tx06.2021
Skills
- Insurance policy knowledge
- Litigating skills
- Insurance regulations knowledge
- Risk Assessment
- Mathematics proficiency
- Creative Problem Solving
- Calm and Professional Under Pressure
- Issue and Complaint Resolution
- Efficient and Detail-Oriented
- Upbeat and Positive Personality
- Verbal and Written Communication
Certification
Adjuster Licensing & Education
Multi-State Adjuster Licensing & State Law Jurisdictional Knowledge:
- TX – Texas (Resident) All Lines
- California
- Colorado
- District of Columbia
- Illinois
- Iowa
- Kansas
- Maryland
- Missouri
- Nebraska
- New Jersey
- North Dakota
- Ohio
- Pennsylvania
- South Dakota
- Tennessee
- Virginia
- Wisconsin
- Florida
Timeline
PIPMPC Claims Adjuster Specialized Team
Statefarm Insurance
05.2022 - Current
Express ECTA Adjuster
The Best Claims Solutions
06.2021 - 04.2022
SR
The Hartford Insurance Co. Remote, Workers Compensation LT & MED Only
05.2014 - 05.2021
SR. Commercial Liability Adjuster
Gallagher Bassett Insurance
02.2008 - 04.2014
Xactimate II certified -
Titanium Licensing Adjusting
B.S. Registered Nurse - Nursing
University of Arlington
Associate of Arts -
Tarrant County College District
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