Lucretia Lemons
Summary
Results-driven Insurance Claims professional with 9 years of expertise in Property and Casualty claims management, adept at navigating the complexities of first-party property claims. Proven ability to provide guidance and oversight to claim handlers, ensuring adherence to operating procedures, policy provisions, and accurate estimating practices. Well-versed in conducting thorough quality reviews, authorizing payments and coverage requests with precision and timeliness. Team-oriented leader with success in building relationships collaboratively, paired with a performance-minded approach, resulting in increased productivity, customer retention and the achievement of mutual business goals. Seeking to procure a position of Property Claims Examiner.
Overview
8
8
years of professional experience
1
1
Certificate
Skills
- Decision Making and Adaptability
- Property and Casualty (P&C) Adjusting
- Claims Management
- Financial Stewardship
- Customer Service
- Risk Management and Fraud Detection
- Rapid Adaptive Learning and Flexibility
- Cross Functional Collaboration and
Communication - Organization and Time Management
- Policy Analysis
- Problem Solving and Critical Thinking
- Technological Proficiency: Advanced Level -Microsoft Office Suite, Telephony and Ticketing Systems, Xactimate, Xact-Analysis, Xact-Contents, Eagleview, Hover, and Verint
- Subrogation and Litigation
Work History
Claims-Inside Prop Analyst
Allstate-National General Ins. Co
2021.11 - Current
- Claims Experience: Authenticates and investigates case files for complex Property claims including Water, Fire, Contents, and Theft, in a Inbound/Outbound virtual call center environment. Analyzes policies, determines coverage, examines property damages and otherwise adjusts and negotiates claims within limits of financial authority. Construction/Restoration Experience: Background in construction, restoration, and mitigation processes, providing valuable insight into property damage assessment and repair processes.
- Customer Centric Approach: Proactively encourages and monitors employees engagement with policyholders and claimants; actively listening to interactions and providing feedback and coaching for areas of improvement and success. Resulting in achieving a remarkable 95% customer satisfaction team rating for claims handling interactions. Cultivates positive working relationships by interacting with stakeholders, section managers, agents, team members, and insureds/claimants, fostering a collaborative and service-oriented environment. Assist and directly addresses escalated customer service issues.
- Drives Operational Efficiency through Technology Management: Strategically leverages and implements advanced proficiency in Microsoft Office applications (Word, Excel, PowerPoint, SharePoint, and Teams); Telephony systems- Avaya and Interaction Desktop, Virtual Estimating and Inspection tools - Xactimate, Xact-Analysis, Xact-Contents and Claims Xperience. Damage Estimation: Skilled in using estimating software to accurately quantify property damage and create repair estimates. Implements and oversees these technologies to optimize the claims analysis lifecycle, leading to a substantial 20% reduction in processing time.
- Independently Oversees Daily Operations of High-Volume Claims Database: Effectively and Independently manages the daily operations of a high-volume claims database, showcasing adept prioritization skills and the ability to handle multiple responsibilities simultaneously within a fast-paced environment. Self manages daily schedule, claims queue, and phone system. Delegates tasks to relevant departments for thorough consulting and resolution, ensuring comprehensive and efficient claim management.
- Communication and Confidentiality: Maintains strict confidentiality with all personal data as per company guidelines. Demonstrates advanced understanding of policies and contracts written by the company, and other industry governing bodies. Engages excellent telephone, virtual, and written communication skills, along with active listening abilities, to convey information clearly and professionally. Maintains adherence to program standards, including compliance with calls, chats, or emails, to maintain the highest standards of confidentiality and ethical conduct.
Insurance Consultant
Volunteer Work
2021.01 - Current
- Scope of Work: Collaborates with Financial Advisor to facilitate Monthly Community Workshops in low economic neighborhoods, to foster and educate clients on successful aspects of properly and economically insuring assets.
- Customer Success: Evaluates client needs and expectations, establishing clear goals for each consulting engagement. Assist's clients in navigating complex industry challenges, offering expert guidance and strategic recommendations. Conduct's thorough market research and analysis, providing valuable insights for client decision making. Provides ongoing support to clients post-implementation, ensuring long-term success of implemented solutions.
- Cross Functional Collaboration: Improves collaboration satisfaction by effectively managing multiple projects and consistently meeting deadlines to maintain presentation calendars. Manages approximately 15 daily incoming calls, and emails per day from customers. Delivers high-quality presentations to stakeholders, effectively communicating project objectives and strategies.
- Follow Up Retrospectives: Negotiates contracts on behalf of clients, securing favorable terms that contributed to their overall success. Facilitates workshops with stakeholder groups to gain consensus on priorities and approaches for tackling identified issues or opportunities. Delivers outstanding service to clients to maintain and extend relationship for future business opportunities.
Claims Specialist
State Farm Mutual Automobile Insurance Company
2020.04 - 2021.11
- Claims Experience: Executed claims adjusting processes, including supervision of claims projects and audits of completed estimates and medical care invoices for all Property and Bodily Injury claims in a virtual call center environment Conducted timely reviews of claims to ensure accuracy and completeness of electronic documentation.
- Strategic Cross-Functional Collaboration and Communication Leadership: Established and fostered strong relationships with stakeholders, external organizations, agents, and attorneys through ongoing collaboration and effective correspondence. Provided strategic education to clients on policy provisions and coverages, ensuring a comprehensive understanding of the claims process and potential outcomes. Played a pivotal role in mentoring team members on policy interpretation and state governance while overseeing claim files, contributing to the professional development and expertise of the team.
- Compliance: Resolved claims efficiently and maintained compliance with state and industry regulations at all times. Strictly followed established confidentiality procedures to maintain customer data and strict confidentiality. Exercised autonomous judgment with respect to claims appeals which may have a very significant impact on the Company in multiple areas across the enterprise.
- Time Management and Multi-tasking: Reviewed outstanding requests and redirected workloads to complete projects on time. Followed up with customers on unresolved issues. Understood and executed requirements for disputes, gathered evidence to support claims and prepared customer cases to handle appeals. Collaborated with upper management and Legal on adjudication avoidance measures
- Technical Proficiency: Utilized, instructed and supported collaborators on matters of technological expertise in the use of Microsoft Office products, Avaya, Xactimate, Xact Contents, Xact Analysis, Verint, Enterprise Claims Systems, and Virtual Inspections software's to complete claims processes and request.
Auto -Total Loss Claims Adjuster
State Farm Mutual Automobile Insurance Company
2016.07 - 2020.04
- Claims Experience: Examined loss vehicles and bodily injury auto claims to determine extent of injury/damage and initiated procurement, ownership transfer and recovery efforts of salvaged vehicles, resulting in a quantifiable increase in claims settlements. Evaluated and investigated over 5000+ auto claims in a fiscal year in a onsite call center environment.
- Documentation Accuracy: Demonstrated proficiency in utilizing state jurisdiction guidelines, repair estimates, medical reviews, medical manuals and third-party vendors to evaluate and analyze claim merits. Prepared written correspondence to stakeholders, external partners, attorneys and engineers. Designed and reviewed completed documents and file notes to emphasize my commitment to maintaining complete and accurate documentation of all calls, chats, and emails, showcasing my attention to detail.
- Customer Service and Collaboration: Enhanced team efficiency and customer service quality by collaborating with management
and other departmental teams to deliver a seamless execution of company practices, while simultaneously maintaining customer satisfaction. Acted as a liaison for cross-functional business units during team training, calibration sessions, and leadership meetings. Heavily collaborated with Agents on matters of document procurement, policy updates and policy renewal recommendations. - Technological Proficiency: Created, Reviewed and Analyzed electronic medical records and invoices for payment under liability guidelines of each applicable policy. Also utilized various technological software such as ECS, Audatex, and virtual estimating tools to examine vehicle damages and estimates and offer settlements for damages to clients.
- Rapid Adaptive Learning and Flexibility: Managed change processes with team members and clients to maintain flow of claims lifecycle. Worked diligently daily to stay abreast of any governmental, ISO and company regulation changes that require rapid deviation form normal process and workflows and learning flexibility in the adoption of the new processes, resulting in a promotion to Subject Matter Expert for all change processes and training programs for the team.
- Analytical Problem Solving and Critical Thinking: Identified and solved client inquiries ranging from policy management, claims procedures to payment methods and options. Utilized various resources and creativity to find or create solutions to issues with no clearly established guidelines for resolutions.
- KPI Metrics Adherence: Successfully Exceeded KPI's such as Verint schedule adherence, Average Answer Time, Average Handling Time, After Call Wrap Ups, SLO, and Days to Close on a monthly monitored basis. Extensive success in KPI metrics resulted in a 25% decrease in claim lifecycle turnaround time, 45% increase in customer satisfaction ratings and a 15% increase in policy and account renewals annually.
Certification
- Property and Casualty Adjuster License - 2016-Currently Active
- AGILE Project Management Course Cert. - 2023
Timeline
Claims-Inside Prop Analyst
Allstate-National General Ins. Co
2021.11 - Current
Insurance Consultant
Volunteer Work
2021.01 - Current
Claims Specialist
State Farm Mutual Automobile Insurance Company
2020.04 - 2021.11
Auto -Total Loss Claims Adjuster
State Farm Mutual Automobile Insurance Company
2016.07 - 2020.04
Associate of Arts - Psychology
University of North Georgia
- Property and Casualty Adjuster License - 2016-Currently Active
- AGILE Project Management Course Cert. - 2023
Education
Associate of Arts - Psychology
University of North Georgia
Oakwood, GA05.2012
Licenses
Property And Casualty Adjuster License, GA- DHS, All 50 states
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