LYDIA EVANS
Carrollton,TX
Summary
Strategic Thinker| Team Lead| Customer Service| Analytical Decision-Maker| Negotiations| Risk Evaluation Responsible Senior Claims Adjuster with experience performing detailed investigations and researching issues. Skilled at interpreting laws, evaluating facts, inspecting damage and analyzing case facts. Handles over 100 caseloads per month and provides exceptional customer service to policyholders.
Motivated Senior Claims Adjuster committed to diligently investigating, evaluating and negotiating CAT and Daily claims for policyholders. Adept at training and supporting new adjusters. Trained and knowledgeable in all state, federal and local laws. Skilled in recognizing potential fraudulent claims.
Resourceful claims professional promoting 8years of expertise assessing coverage and overseeing claims review. Leverages well-developed communication skills to deliver information to policyholders.
Overview
12
12
years of professional experience
Work History
Claims Examiner
UPC Insurance
08.2021
- With defense counsel on high exposure complex claims
- Negotiate represented claims in lieu of appraisal and/or suit with 95% settlement rate
- Review and refer claims to appraisal
- Negotiated on pre-suit and post appraisal demands with defense counsel and Public Adjusters
- Collaborate with field adjusters, appraisers, attorneys and public adjusters for claim direction
- Prepare claim summary and reports for final approvals
- Prepare release of claim per successful negotiations
- Acknowledge, analyze and identify claim issues through fact analysis
- Investigate, confirm and interpret coverage while working toward resolve
- Establish and manage expense reserves
- Participate in roundtable with management and counsel to determine best course of action
- Ability to reconcile and validate Xactimate estimates
- Worked with private investigators and attorneys on preparation of evidence, witness statements and other documentation in preparation for claim negotiations
- Handled complaints and grievances using negotiating and problem-solving skills
- Interviewed claimants and witnesses to gather factual information
- Examined claims forms and other records to determine insurance coverage
- Identified insurance coverage limitations with thorough examinations of claims documentation and related records
- Resolved complex, severe exposure claims using high service oriented file handling
Supervising Adjuster
Florida Peninsula
02.2023 - 08.2023
- Review newly submitted attorney and/or public adjuster documents for supplement revisions
- Utilize Xactimate for all claim revisions
- Collaborate with field adjusters, attorney and public adjusters for claim direction and negotiation
- Prepare claim summary and reports for final approvals
- Effectively communicate with insureds, representatives and all levels of management.
- Directed claims negotiations within allowable limit of $100k and supported successful pre-litigations for advanced issues
Claims Examiner/Supplement Adjuster
ACM-American Claims Management
01.2021 - 08.2021
- Handle team customer service complaints and escalations
- Provide resolution action plan to agents and upper management where necessary
- Provide coaching to less experienced adjusters
- Calculate and approve settlement of claim within authority
- Perform thorough investigation, confirm and interpret coverage with insureds, agents and management
- Determine coverage by investigating damages and negotiate claim settlement in accordance with business best practices
- Ability to reconcile and validate Xactimate estimates
- Review, negotiate and reconcile mid to high supplements.
- Directed claims negotiations within allowable limit of $50k and supported successful pre-litigations for advanced issues
Claims Examiner
Bear River Mutual
09.2020 - 01.2021
- Negotiate and settle property losses with no oversight
- Calculate and approve settlement of claim within authority
- Perform thorough investigation, confirm and interpret coverage with insureds, agents and management
- Ability to reconcile and validate Xactimate estimates
- Assist in training and mentoring adjusters on request
- Review, negotiate and reconcile mid to high supplements
- Maintain daily diary to manage inventory.
Complex Desk Adjuster
Sedgwick
02.2019 - 09.2020
- Determine coverage by investigating damages and negotiate claim settlement in accordance with business best practices
- Adjust and negotiate claims involving litigation, arbitration or mediation requiring coordination with legal counsel and public adjuster
- Respond to Civil Remedy Notices and DOI complaints prior to suit
- Apply discretion to help solve problems of various scope and complexity
- Substantiated legitimate claims and denied unjustified claim
- Review, negotiate and reconcile mid to high supplements
- Review assignment of benefits for accuracy
- Draft investigative reports covering all phases of claim
- Review litigation claims and maintain contact with claimants and attorneys to determine treatment status.
- Directed claims negotiations within allowable limit of $50k and supported successful pre-litigations for advanced issues
Claims Adjuster
Liberty Mutual
04.2016 - 02.2019
- Claims Adjuster and Supervisor who investigates Daily/CAT Claims- water, hail/wind, water, sewage, backup, ice, ice dam, freeze, theft, vandalism, hurricane and mold.
Home Equity Underwriter I
Capital One Bank
06.2011 - 01.2016
- Balanced the need for loan-volume growth with the equally important necessity of optimum underwriting quality to minimize risk while maximizing profitability
- Leveraged knowledge of loan products to help restructure turned-down loans for subsequent approvals
- Maintained compliance with lending, underwriting and government requirements
- Maintained meticulous attention to detail in underwriting mortgages
- Evaluated the financial strength of borrowers to determine risk and repayment capacity
- Demonstrated excellent follow-through with borrowers, loan processors, loan originators and management throughout all phases of the underwriting process.
Education
Master of Science - Masters of Management
University of Phoenix
Dallas, TX05.2007
Skills
- Exceptional oral and written communication skills
- Strong time management and organizational skills
- Initiative for critical thinking
- Settlement Negotiations
- Regulatory Compliance
- Risk Management
- Underwriting Knowledge
- Coaching and Mentoring
- Team Training
- Team Leadership
- MS Office
Timeline
Supervising Adjuster
Florida Peninsula
02.2023 - 08.2023
Claims Examiner
UPC Insurance
08.2021
Claims Examiner/Supplement Adjuster
ACM-American Claims Management
01.2021 - 08.2021
Claims Examiner
Bear River Mutual
09.2020 - 01.2021
Complex Desk Adjuster
Sedgwick
02.2019 - 09.2020
Claims Adjuster
Liberty Mutual
04.2016 - 02.2019
Home Equity Underwriter I
Capital One Bank
06.2011 - 01.2016
Master of Science - Masters of Management
University of Phoenix
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