Lani Sinclair
Kapolei,HI
Summary
Results-driven insurance professional ready to bring extensive claims management expertise of over 25 years to a new role. Adept at resolving complex claims and fostering positive client relationships. Known for collaborative team spirit and adaptability to evolving demands. Skilled in policy analysis and effective communication.
Overview
30
30
years of professional experience
1
1
Certification
Work History
Financial Advisor
Finesse & Associates
09.2024 - Current
- Built strong relationships with clients, fostering trust and loyalty in managing their financial portfolios.
- Educated clients on various financial matters and provided professional recommendations on investment opportunities, products, and services based on each clients' individual needs.
- Developed personal rapport with each client to maintain customer loyalty and establish long-term accounts.
- Established new client relationships by conducting thorough needs assessments during initial consultations.
- Developed comprehensive financial plans for clients to achieve short-term and long-term goals.
- Identified opportunities for business growth by networking, attending industry events, and generating referrals from satisfied clients.
- Manage approximately 30 incoming calls, emails and fazes per day from customers.
Claim Examiner II
TRISTAR Insurance Group
03.2023 - 02.2024
- Effectively manages a caseload of 160 to 175 TDI claims.
- Initiates and confirms eligibility in a timely manner.
- Determines eligibility of claims and administer benefits, based upon state laws/Rules and in accordance with established Company guidelines.
- Communicates with claimants, employers, carriers and providers regarding claims issues.
- Administers TDI benefits timely and within Company/Client guidelines.
- Actively pursues subrogation when applicable.
- Maintains diary system for case review and documents file to reflect the status and work being performed on the file.
- Regularly review claims for closure once outstanding issues are resolved.
- Communicates appropriate information promptly to the client to resolve claims efficiently.
- Adheres to all Company policies and procedures.
- Adheres to agreed client handling instructions.
Automobile Subrogation Arbitrator
Arbitration Forums
06.2014 - 01.2021
- Applying laws, procedures and industry knowledge to settle cases with a written decision.
- Skilled at working independently and collaboratively in a team environment.
- Hear and decide the outcome of arbitration filings from other companies as an arbitration panelist following management directives.
- Assess new files to determine completeness of investigation and factual evidence (scene investigations, police reports, statements).
- Analyze factual information to determine appropriate liability percentage to maximize subrogation recoveries. Handle claims involving multiple insureds/carriers, product liability, and fire losses.
- Exhibits basic knowledge of unfair claim practice acts, corporate claim standards, company claim bulletins and the company code of ethics. Handle claims in good faith.
- Ability to write quality contentions based on evidence and claims facts
- Strong understanding of legal liability, including statutes and jurisdictions
- Understand and apply applicable case law and statutes, considering geographic location and local ordinances.
- Proven ability to learn quickly and adapt to new situations.
- Self-motivated, with a strong sense of personal responsibility.
- Excellent communication skills, both verbal and written.
- Worked well in a team setting, providing support and guidance.
- Worked effectively in fast-paced environments.
Senior Claims Representative
Farmers Insurance Hawaii
02.1995 - 01.2021
- Interpersonal skills working with customers in stressful and crisis situations
- Knowledgeable in investigating coverages, interpret automobile policies, laws and regulations
- Worked closely with body shops, vendors to negotiate repairs and payments
- Handled multi line, fire, theft, property damage, commercial and total loss claims from opening to closing
- Completed recorded statements, setting up repairs, rental and towing
- Trained claims associates in manual coding coverages
- Worked in claims call center
- Received award for excellence in claims, outstanding performance in superior service.
- Conducted investigations into complicated mid- and high-exposure claims.
- Worked productively in fast-moving work environment to process large volumes of claims.
- Analyzed and addressed escalated claims to resolve issues quickly.
- Monitored and managed claim expenses to control costs and maximize profitability.
- Followed up with customers on unresolved issues.
- Examined reports, accounts, and evidence to determine integrity and accuracy of information.
- Interviewed policyholders to verify information and obtain additional details.
- Recommended and set reserves based on expected payouts.
- Researched and analyzed complex claims to determine next steps and possible outcomes.
- Collaborated with internal departments and external vendors to achieve fast resolution of claims.
- Negotiated claim settlements with claimants and attorneys to resolve claims efficiently and fairly.
- Collaborated with legal and medical professionals to gather necessary information for claim assessments.
- Analyzed complex claims data, identifying trends, and recommending improvements to reduce future risks.
- Enhanced customer satisfaction with timely and accurate resolution of claims disputes.
- Actively contributed to continuous improvement initiatives within the organization aimed at refining claims handling procedures and customer service standards.
- Managed approximately 60 incoming calls, emails and faxes per day from customers.
Education
High School Diploma -
Konawaena High School
Kealakekua, HI09.1989
Skills
- Adaptability
- Creativity
- Critical thinking
- Communication
- Computer literacy
- Emotional intelligence
- Inclusiveness
- Teamwork
- Organization
Accomplishments
- Collaborated with team of 12 in the development of consolidation of claim handling and going paperless.
- Documented and resolved liability dispute which led excellent customer service award.
Certification
- Interpreting medical reports
- Claims investigation
- Negotiations skills
- Licensed Adjuster HI - DCCA Insurance Division: Independent Adjuster and Insurance Produced (Life)
Timeline
Financial Advisor
Finesse & Associates
09.2024 - Current
Claim Examiner II
TRISTAR Insurance Group
03.2023 - 02.2024
Automobile Subrogation Arbitrator
Arbitration Forums
06.2014 - 01.2021
Senior Claims Representative
Farmers Insurance Hawaii
02.1995 - 01.2021
High School Diploma -
Konawaena High School
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