Karen Scott
Allen,TX
Summary
Detail-oriented and client-focused Claims Manager/Adjuster with exemplary customer service, negotiation, crisis communication and analytical skills. Experience within the liability and catastrophe insurance claim arena coupled with expertise in providing seamless insurance claim support and customer service. History of representing employers with a highly professional image through client contact and proactive phone communication. Reputation for avoiding conflict by demonstrating compassion and empathy. Background of carefully investigating situations and providing above average solutions. Motivational leader and organizational problem-solver with advanced supervisory, team building and customer service skills. Experience stepping into roles and quickly making positive changes to drive company success. Focused on using training, monitoring and morale-building techniques to maximize employee engagement and performance.
Overview
26
26
years of professional experience
1
1
Certification
Work History
AUTO TOTAL LOSS MANAGER
CRAWFORD SERVICES - STATE FARM
Irving, TX
06.2022 - 04.2023
- Managed claim staff of 16 with ongoing handling of new and existing losses within the ECS platform
- Monitor quality, complete silent phone monitoring and file reviews and provide direction to bring claims to closure in an effective and timely manner
- Managed daily workflow and quality of claims handling within the unit
- Attendance and timekeeping approval and reviews for accuracy
- Maintain an on-going diary in accordance with company guidelines
- Reviewed files for coverage and/or authority limit compliance
- Provided training as an essential component to the delivery of a seamless claim handling product.
- Coached, mentored and trained team members in order to improve their job performance.
- Conducted regular meetings with staff to discuss progress and identify areas of improvement.
- Established processes to ensure efficient workflow throughout the organization.
- Resolved conflicts between employees by providing guidance on company policies and procedures.
- Maintained up-to-date records of employee attendance, payroll information, vacation requests.
- Assessed team member's skillsets and assigned tasks accordingly for optimal efficiency.
- Ensured compliance with all applicable laws, regulations, industry standards.
- Enforced customer service standards and resolved customer problems to uphold quality service.
- Assigned tasks to associates to fit skill levels and maximize team performance.
- Led team meetings and one-on-one coaching sessions to continuously improve performance.
- Conducted quality, timely performance feedback and performance appraisals.
- Communicated company directives and programs to associates and ensured all follow-up items were completed accurately and timely.
- Entered time and attendance logs in preparation for payroll.
AUTO TOTAL LOSS/LIAB CLAIM ADJUSTER
PILOT CATASTROPHE, ALLSTATE INSURANCE
Coppell, TX
10.2018 - 06.2022
- Expert in the use of NextGen, Interactions, Huddle Board, Knowledge Library, Verint and SharePoint Explained coverages, repair options
- Proficient in claim file ownership
- Coordinate rental, salvage recovery, settlement and initiate subrogation
- Seamlessly coordinate vehicle inspections, communicate effectively with repair facilities to coordinate supplements, when necessary, obtain titling documentation, manage diary, managing salvage and titling documents, review and extend rental coverage, coverage verification, effectively communicate with lienholders in addition to processing lienholder and insured payments
- Assist with training as needed.
- Investigated insurance claims to determine liability and damages.
- Negotiated settlements with claimants, attorneys and other parties.
- Drafted correspondence related to claim investigations and settlements.
- Assessed potential losses for insureds in accordance with applicable laws and regulations.
- Evaluated subrogation opportunities to identify recoverable funds.
- Maintained detailed records of all claim activities in a timely manner.
- Reviewed property damage estimates for accuracy and completeness.
- Established reserves for each claim based on analysis of the facts and applicable law.
- Ensured compliance with regulatory requirements relating to claims handling.
- Coordinated activities between multiple departments within the company.
- Documented date, parties involved and specific details about incidents.
- Negotiated total loss settlements by reasonably applying company estimates to benefit both client and company needs.
- Conducted witness interviews to assist claim information gathering process.
- Identified and collected evidence and determined value to specific claim to properly assess conditions.
- Completed required investigations on referred files within established timeframes.
- Explained premiums owed to policyholders, agents and underwriters.
- Coordinated benefits while applying applicable deductibles, co-insurance and out-of-pocket costs.
- Reviewed, evaluated and adjusted claims to promote fair and prompt settlement.
- Negotiated and settled claims according to information presented through reports, research and data verification.
AUTO LIABILITY MANAGER
EBERL CLAIM SERVICE
Irving, TX
11.2017 - 09.2018
- Managed claim staff of 20 with ongoing handling of new and existing losses within the ECS platform
- Monitor quality, complete reviews and provide direction to bring claims to closure in an effective and timely manner
- Managed daily workflow and quality of claims handling within the unit
- Monitored and conducted quality control audits within the unit
- Maintain on-going diary in accordance with company guidelines
- Reviewed files for coverage and/or authority
- Monitor unit performances against established performance and quality standards
- Timekeeping and attendance review/approval.
- Coached, mentored and trained team members in order to improve their job performance.
- Conducted regular meetings with staff to discuss progress and identify areas of improvement.
- Established processes to ensure efficient workflow throughout the organization.
- Resolved conflicts between employees by providing guidance on company policies and procedures.
- Maintained up-to-date records of employee attendance, payroll information, vacation requests.
- Assessed team member's skillsets and assigned tasks accordingly for optimal efficiency.
- Ensured compliance with all applicable laws, regulations, industry standards.
- Monitored staff performance and addressed issues.
- Enforced customer service standards and resolved customer problems to uphold quality service.
- Exercised good judgment and decision-making in escalating concerns and resolving issues.
- Communicated company directives and programs to associates and ensured all follow-up items were completed accurately and timely.
- Conducted quality, timely performance feedback and performance appraisals.
- Led team meetings and one-on-one coaching sessions to continuously improve performance.
AUTO TOTAL LOSS/LIAB CLAIM REP
PILOT CATASTROPHE, ALLSTATE INSURANCE
Coppell, TX
08.2017 - 11.2017
- Explain coverages, repair options
- Claims file ownership
- Coordinate rental, recorded statements, salvage recovery, settlement
- Initiate subrogation
- Seamlessly coordinate vehicle inspections, communicate effectively with repair facilities to coordinate supplements, when necessary, obtain titling documentation, manage diary, managing salvage and titling documents, review and extend rental coverage, coverage verification, process lienholder and insured payments.
- Delivered exceptional customer service to clients by communicating information and actively listening to concerns.
- Prepared various reports documenting findings and recommendations regarding claims resolution.
- Communicated with claimants, attorneys and other parties involved in the process.
- Maintained detailed records of all activities related to each claim file.
- Negotiated settlements with claimants as appropriate within established guidelines.
- Ensured compliance with applicable state laws, regulations and standards of practice.
- Reviewed and evaluated customer claims to determine coverage eligibility.
- Assessed claim accuracy according to company policies and procedures.
- Verified liability extent with reviews of police reports, medical treatment histories and other records.
AUTO TOTAL LOSS/LIAB CLAIM REP/TRAINER
EBERL CLAIM SERVICES (STATE FARM INS)
Irving, TX
12.2012 - 05.2017
- Accomplished staff job results by coaching, counseling, and disciplining employees, provide daily and monthly reports, conducted unit meetings, complete claim audit reviews, maintained quality service by assuring prompt and accurate handling of claims, address escalated complaints, ensure all files are consistent and are in adherence to company and state policies and procedures, maintain relationships with vendors and customers
- Designed and developed training materials for new employees in the organization.
- Conducted onboarding sessions to orientate new staff members about company policies and procedures.
- Provided feedback on employee performance based on observed results during training sessions.
- Documented all training activities including attendance records, feedback forms, surveys.
- Adapted teaching methods according to the needs of individual learners or groups.
- Recommended changes or improvements in existing training processes as needed.
- Resolved any issues raised by participants during the training session in a timely manner.
- Evaluated individuals regularly for progress or growth potential to guide decisions regarding advancement and additional training.
- Monitored training effectiveness through observation and metrics analysis.
- Created tests, exercises and role-plays for courses to verify competency.
HEALTHCARE PROVIDER APPEAL ANALYST/CLAIM EXAMINER
AETNA
Hartford, CT
06.1997 - 03.2012
- Research claim processing logic to verify accuracy of claim payment, member eligibility data, and payment status prior to initiating appeal process
- Triage incomplete components of complaints/appeals to the appropriate subject matter expert within another business unit(s) for resolution response content to be included in final resolution response
- Identify trends and emerging issues and report on and give input on potential solutions
- Efficient in all areas of claims insurance/healthcare, including: 14 years of experience that includes HMO, Traditional, POS, ASO, PPO, Commercial Managed Care; Medicare Advantage; Indemnity; Medicaid plans and Division of Financial Responsibility claim platforms, products, and benefits; patient management; product or contract drafting compliance and regulatory analysis; special investigations
- Explain member benefits and responsibilities, perform effective service recovery, access information from a variety of systems and references, answer inquiries and resolve issues in a timely manner and document contacts with members and providers
- Process medical/hospital claims according to HCFA and DOC guidelines on ACAS system
- Audit HMO/IPA claims for payment issuance
- Usage of RBRVS, ICD-9, CPT and HCPCS.
Education
General Studies -
Pasadena High School
06-1974
Skills
- Enterprise Claim System (ECS)
- Audatex
- Mitchell software
- Workforce Management
- Staff Development
- Policy Implementation
- Performance Management
- Operations Management
- Performance Evaluations
- Time Management
- Staff Training and Development
- Key Performance Indicators
- Staff Management
- Team Leadership
- Verbal and Written Communication
- Critical Thinking
- Liability Determination
- Strong Analytical Skills
- Damage Assessment
- Claims Investigation
- Policy Interpretation
- Multi-Line Phone System
- Claims Investigations
- Claims Handling
- Professionalism
- Effective Communication
- Team Building
- Proficient in Microsoft Office products
- Active Listening
- Task Prioritization
- Multitasking
- Attention to Detail
- Excellent Communication
- Dispute Resolution
Certification
- Texas All Lines License Number: 1696727
- Alabama
- Alaska
- Arizona
- Arkansas
- Connecticut
- Delaware
- Florida
- Georgia
- Idaho
- Indiana
- Iowa
- Kentucky
- Louisiana
- Michigan
- Mississippi
- Minnesota
- Nebraska
- Nevada
- North Carolina
- New Hampshire
- Maine
- New Mexico
- New York
- Oklahoma
- Rhode Island
- South Carolina Adjuster/Appraiser
- Tennessee
- Texas
- Utah
- Washington
- Wyoming
- TWIA
- LCPIC
Passport Expiration
2036
References
References available upon request.
Timeline
AUTO TOTAL LOSS MANAGER
CRAWFORD SERVICES - STATE FARM
06.2022 - 04.2023
AUTO TOTAL LOSS/LIAB CLAIM ADJUSTER
PILOT CATASTROPHE, ALLSTATE INSURANCE
10.2018 - 06.2022
AUTO LIABILITY MANAGER
EBERL CLAIM SERVICE
11.2017 - 09.2018
AUTO TOTAL LOSS/LIAB CLAIM REP
PILOT CATASTROPHE, ALLSTATE INSURANCE
08.2017 - 11.2017
AUTO TOTAL LOSS/LIAB CLAIM REP/TRAINER
EBERL CLAIM SERVICES (STATE FARM INS)
12.2012 - 05.2017
HEALTHCARE PROVIDER APPEAL ANALYST/CLAIM EXAMINER
AETNA
06.1997 - 03.2012
General Studies -
Pasadena High School
- Texas All Lines License Number: 1696727
- Alabama
- Alaska
- Arizona
- Arkansas
- Connecticut
- Delaware
- Florida
- Georgia
- Idaho
- Indiana
- Iowa
- Kentucky
- Louisiana
- Michigan
- Mississippi
- Minnesota
- Nebraska
- Nevada
- North Carolina
- New Hampshire
- Maine
- New Mexico
- New York
- Oklahoma
- Rhode Island
- South Carolina Adjuster/Appraiser
- Tennessee
- Texas
- Utah
- Washington
- Wyoming
- TWIA
- LCPIC
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