Kimberly C. Kooker, SCLA
Claims Investigator
Winnfield,LA
Summary
Insurance Adjuster skilled in investigating and analyzing liability concerning personal, casualty or property loss. Proven history of leveraging excellent negotiation skills to facilitate settlements. Superior communication skills, interviewing specialists, witnesses and claimants to compile information.
Overview
14
14
years of professional experience
1
1
Certification
Work History
Subrogation Adjuster
Crawford & Co Risk Management
Peachtree Corners, GA
12.2021 - Current
- Conducted thorough property investigations to identify and classify damages for customer claims.
- Reviewed and analyzed suspicious and potentially fraudulent insurance claims.
- Evaluated original investigation reports and documents to resolve secondary concerns.
- Researched claims and incident information to deliver solutions and resolve claim.
- Estimated quantifiable characteristics of Construction defects products.
- Assisted in the development and training plans based on department needs and objectives.
- Trained new members and assisted in professional growth of employees
- Selected to develop first Charter Council Employee Committee for division.
- Maintained strict confidentiality with all personal data as per company guidelines
- Prepared insurance claim forms or related documents and reviewed for completeness.
- Used critical thinking to break down problems, evaluate solutions and make decisions.
- Demonstrated strong organizational and time management skills while managing multiple projects.
- 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.
- Prepared written opinions or decisions regarding cases.
- Conducted interviews with disputants, witnesses and any additional relevant groups or individuals.
Adjuster
Self Employed
Lake Charles, LA
02.2018 - 11.2021
- Analyzed information gathered by investigations to report findings and recommendations.
- Investigated and assessed damage to property and reviewed property damage estimates.
- Followed up with insured individuals regarding premium and deductibles payments.
- Answered customer questions regarding deductibles.
- Maintained claims data in Xactimate systems.
- Prepared summaries of damage, payments and policy coverage.
- Investigated and assessed damage to property and reviewed property damage estimates
- Examined claims forms and other records to determine insurance coverage
- Followed up with insured individuals regarding premium and deductibles payments
- Substantiated legitimate claims and denied unjustified claims.
- Negotiated with policyholders and claimants to reach mutually satisfactory resolutions.
- Evaluated insurance policies and analyzed damages to determine coverage.
- Documented all investigation activity and presented reports to management.
Safety Coordinator
PSC
LAKE CHARLES, United States
10.2016 - 01.2018
- Accompanied, documented and reported OSHA inspections, insurance oversight and other formal safety and security measures at work site.
- Identified accident causes and optimal prevention strategies by conducting thorough investigations and analyses.
- Used critical thinking to break down problems, evaluate solutions and make decisions.
- Led projects and analyzed data to identify opportunities for improvement.
- Conducted incident investigations, participated in audits and collected data and information to maximize workplace safety.
- Created safe work environment by complying with safety, health and security requirements.
- Developed new training programs to address performance and knowledge issues.
- Investigated accidents and hazardous incidents to determine cause and made recommendations for corrective action.
- Recognized, documented and advised on removal of hazards.
- Provided assistance in managing health and safety programs aligned with industry standards.
- Assist HR with workers' compensation claims.
Safety Coordinator
S-Con
Grapeland, TX
01.2014 - 09.2016
- Recommended changes to company culture to improve safety and meet changing demands.
- Conducted safety audits and investigated plant quality issues.
- Recognized, documented and advised on removal of hazards.
- Conducted investigations into incidents and reported on findings.
- Investigated accidents and hazardous incidents to determine cause and made recommendations for corrective action.
- Inspected facilities for adherence to fire, hazard and safety guidelines.
- Recommended measures to help protect workers from potentially hazardous work methods, processes and materials.
- Conducted investigations into incidents and reported on findings.
- Designed programs, policies and procedures that were implemented to reduce or eliminate workplace injuries and hazards.
- Assist HR with workers' compensation claims.
Insurance Claims Specialist
TEJ
Natchitoches, LA
01.2010 - 01.2015
- Followed up with customers on unresolved issues.
- Conducted full claim investigations and reported updates and legal actions.
- Determined appropriateness of payers to protect organization and minimize risk.
- Maintained strong knowledge of basic medical terminology to better understand services and procedures.
- Coordinated with contracting department to resolve payer issues.
- Checked documentation for accuracy and validity on updated systems.
- Notified insurance agents and accounting departments of policy cancellations and changes.
- Processed and recorded new policies and claims.
- Prepared insurance claim forms or related documents and reviewed for completeness.
- Investigated damages, gathering information from diverse sources and delivering comprehensive reports.
- Worked with claims adjusters and examiners to expedite processing in alignment with procedures.
- Evaluated and settled complex insurance claims in strict timeframes.
- Affirmed or denied coverage fairly based on thorough investigations.
Education
High School Diploma -
St. Amant High School
Saint Amant, LA05-2006
Skills
- Policy investigations
- Personal, casualty and property loss
- Valuation knowledge
- Accident scene investigations
- Negotiation and mediation skills
- Claims Review
- Coverage Determination
- Claims History Analysis
- Negotiation and Mediation Skills
- Subrogation Expertise
- Rules of Evidence
- Insurance Fraud Expertise
- Workers' Compensation Claims
- Negotiate Settlements
- Xactimate Specialist
- Claims Investigations
- Hail and Wind Damage Assessment
- Federal, State, and Local Regulatory Statutes
- Property Claims
- Automobile Claims Specialist
- Familiar with Fraud Statutes
- Legal Proceedings Knowledge
- Investigate Property Damage
- Building Construction Knowledge
Certification
Senior Claims Law Associate, SCLA
Timeline
Subrogation Adjuster
Crawford & Co Risk Management
12.2021 - Current
Adjuster
Self Employed
02.2018 - 11.2021
Safety Coordinator
PSC
10.2016 - 01.2018
Safety Coordinator
S-Con
01.2014 - 09.2016
Insurance Claims Specialist
TEJ
01.2010 - 01.2015
High School Diploma -
St. Amant High School
Similar Profiles
Karen Jimenez ManlapazKaren Jimenez Manlapaz
Team Manager at Crawford and Company GBSC - Broadspire (Integrated Claims and Medical Management Services)Team Manager at Crawford and Company GBSC - Broadspire (Integrated Claims and Medical Management Services)
Diana AndersonDiana Anderson
Customer Service Representative at Insight Risk ManagementCustomer Service Representative at Insight Risk Management
Melissa McGoughMelissa McGough
Executive Director at Carle Risk Management CompanyExecutive Director at Carle Risk Management Company
Kristyn ParkerKristyn Parker
Food Truck Manager, Grounds & Vehicle Maintenance at Louisiana Adult & Teen ChallengeFood Truck Manager, Grounds & Vehicle Maintenance at Louisiana Adult & Teen Challenge
Amanda WootenAmanda Wooten
Case Manager/Utilization Review Nurse at Healthcare ComplianceCase Manager/Utilization Review Nurse at Healthcare Compliance