Xactimate
Luceile Waldron
Fort Myers
Summary
Dynamic Quality Assurance Adjuster with a proven track record at RYZE Claims Solutions, excelling in claims investigation and damage assessment. Recognized for enhancing customer satisfaction through effective communication and critical thinking. Successfully managed high caseloads while ensuring compliance with insurance regulations, resulting in improved processing efficiency and timely claim resolutions.
Experienced with evaluating insurance claims and determining appropriate actions. Utilizes analytical skills to assess damage and liability. Strong understanding of policy coverage and effective negotiation techniques.
Overview
24
24
years of professional experience
1
1
Certification
Work History
Quality Assurance Adjuster
Ryze Claims Solutions
04.2015 - 03.2025
- Maintained strong relationships with policyholders, agents, and colleagues by consistently demonstrating professionalism, empathy, and effective communication skills.
- Ensured compliance with state regulations and company policies through diligent review of all claim-related materials.
- Assisted clients in understanding their insurance coverage by explaining complex terms and conditions clearly and concisely.
- Investigated and assessed damage to property and reviewed property damage estimates.
- Contributed to team success by participating in regular training sessions, sharing best practices, and mentoring new adjusters.
- Examined claims forms and other records to determine insurance coverage.
- Improved claim processing efficiency by conducting thorough investigations and promptly addressing discrepancies.
- Analyzed information gathered by investigations to report findings and recommendations.
- Managed catastrophe response efforts during natural disasters, ensuring prompt service to affected policyholders and efficient resource allocation within the team.
- Increased overall productivity by managing a large caseload while maintaining strict attention to detail and accuracy in documentation.
- Participated in ongoing professional development opportunities to maintain current knowledge of insurance laws, regulations, and best practices within the field of claims adjustment.
- Enhanced client satisfaction by providing timely updates and effectively resolving claim disputes.
- Developed comprehensive reports outlining investigation findings, settlement recommendations, and supporting evidence for use in both internal reviews and external negotiations.
- Reduced backlogs of pending claims using effective time-management strategies such as prioritizing tasks based on urgency or complexity levels.
- Verified insurance claims and determined fair amount for settlement.
- Prepared summaries of damage, payments, and policy coverage.
- Conducted day-to-day administrative tasks to maintain information files and process paperwork.
- Analyzed information gathered by investigation and reported findings and recommendations.
- Identified insurance coverage limitations with thorough examinations of claims documentation and related records.
- Read over insurance policies to ascertain levels of coverage and determine whether claims would receive approvals or denials.
- Researched claims and incident information to deliver solutions and resolve problems.
- Documented information gathered in field and uploaded data to company database for efficient processing using Xactimate and Symbility.
- Maintained claims data in Radius systems.
Property Claims Adjuster
USAA
10.2000 - 04.2015
- Exercised proper judgment and decision making to analyze over 30-50 claims per week.
- Improved overall department performance metrics by consistently meeting or exceeding goals related to cycle time, productivity levels, and customer satisfaction ratings.
- Reduced company expenses by accurately determining coverage and negotiating cost-effective settlements with policyholders.
- Streamlined the claims process for increased efficiency by consistently updating claim files and maintaining accurate records.
- Maintained compliance with state regulations and company guidelines through diligent adherence to policies and procedures.
- Managed high caseloads effectively by prioritizing tasks based on complexity and urgency of claims.
- Collaborated with contractors to verify repair estimates, ensuring fair settlements for both policyholders and company.
- Assisted policyholders with understanding their coverage, providing clear explanations on policy terms and conditions throughout the claims process.
- Mentored junior adjusters, providing guidance on best practices for efficient claims handling and decision-making processes.
- Continuously improved industry knowledge through ongoing professional development opportunities, staying current on trends and changes within the insurance field.
- Enhanced customer satisfaction with prompt communication and consistent follow-up on claim status updates.
- Coordinated with other departments as needed to support claim resolution efforts, including working closely with underwriting teams to address policy-related questions or concerns.
- Prepared reports of findings of investigations.
- Achieved timely resolution of property claims by investigating, evaluating, and settling a variety of cases.
- Established a reputation for sound decision-making and exceptional customer service, contributing to positive feedback from both clients and colleagues within the company.
- Facilitated smooth transitions during catastrophes as part of a disaster response team, quickly addressing large volumes of claims while maintaining high-quality service standards.
- Developed strong relationships with clients, fostering trust throughout the claims process.
- Conducted thorough inspections to document property damages, resulting in accurate claim evaluations.
- Increased accuracy in damage assessments by utilizing advanced technology tools during inspections.
- Scoped and photographed properties for defects and damage.
- Prepared sketch of floor plan and roofline and entered data into Xactimate to develop line-by-line item costs of damages.
- Prepared comprehensive reports to negotiate purchase price and repair of properties.
- Carefully reviewed claim information to verify accuracy and avert fraudulent claims.
- Investigated claims by reviewing policy contracts to determine claim coverage based on cause and facts of loss.
- Used Xactimate to compile estimates for personal property and structure damage.
- Developed and maintained working relationships with independent adjusters and contractors to assist in prompt claims handling.
- Developed effective techniques to mitigate losses.
- Delivered exceptional customer service to policyholders by communicating important information and patiently listening to issues.
- Identified suspicious losses and contacted manager for investigative assistance.
- Clarified coverage of losses to policyholders and provided assistance in itemizing damages and finding alternative living arrangements.
- Identified insurance coverage limitations with thorough examinations of claims documentation and related records.
- Examined claims forms and other records to determine insurance coverage.
- Evaluated original investigation reports and documents to resolve secondary concerns.
- Maintained claims data in Claims Management Systems.
- Read over insurance policies to ascertain levels of coverage and determine whether claims would receive approvals or denials.
- Conducted day-to-day administrative tasks to maintain information files and process paperwork.
- Researched claims and incident information to deliver solutions and resolve problems.
- Analyzed information gathered by investigation and reported findings and recommendations.
- Investigated and assessed damage to property and reviewed property damage estimates.
- Assisted homeowners by coordinating vendor services, emergency repair, cleaning and contractors.
Education
Associate of Science - Business Administration
St Leo University
St. Leo, FLSkills
- Claims investigation
- Damage assessment
- Property valuation
- Policy interpretation
- Insurance regulations
- Critical thinking
- Quality control
- Active listening
- Decision-making
- Claims processing
- Advanced computer skills
- Caseload management
- Report writing
- Florida claims adjuster license
Certification
- Associate in Claims (AIC)
Work Availability
monday
tuesday
wednesday
thursday
friday
saturday
sunday
morning
afternoon
evening
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Software
Symbility
Timeline
Quality Assurance Adjuster
Ryze Claims Solutions
04.2015 - 03.2025
Property Claims Adjuster
USAA
10.2000 - 04.2015
Associate of Science - Business Administration
St Leo University
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