Job Search Status
Open to workDesired start date: 2 weeks notice
Open To Work
MaeLoni Lee
Adjuster
Nevada,TX
Work Preference
Summary
Dynamic professional with 10 years in claims management, specializing in negotiating fair settlements and streamlining claims processing. Adept at assessing property damage, collaborating with stakeholders, and providing comprehensive updates to policyholders throughout the claims process.
Overview
8
8
years of professional experience
Work History
Weather Catastrophe Field Claim Specialist
State Farm Fire
10.2022 - 04.2026
- Assess and evaluate property damage caused by natural disasters, such as hurricanes, earthquakes, floods, and other catastrophic events
- Investigated insurance claims, determined coverage, documented damages, and facilitated on-site claims settlement process to ensure timely resolution.
- Utilize specialized tools and software to accurately assess damages and estimate repair costs
- Communicate with policyholders, insurance agents, and other relevant parties to explain the claims process and gather necessary information
- Provide clear and timely updates to policyholders regarding the status of their claims
- Review insurance policies to determine coverage and liability in relation to reported damages
- Gather evidence, statements, and documentation to support claims investigations and decision-making
- Create detailed and accurate reports outlining the findings of the investigation, assessment of damages, and recommended claim settlements
- Document all interactions, assessments, and decisions in a systematic and organized manner
- Negotiate with policyholders and third-party contractors to reach fair and equitable settlements that align with policy terms and coverage
- Collaborate with other adjusters, support staff, and internal teams to ensure smooth and efficient claims processing during catastrophic events
- Processed claims using industry-standard software systems efficiently and accurately.
- Trained junior staff on claims processing procedures and best practices.
- Managed claim disputes by investigating cases and negotiating resolutions effectively.
- Maintained organized records of all claim activities and communications for reference.
- Resolved claims by approving or denying documentation, calculating settlements across all coverages.
- Processed payments for valid claims according to established procedures.
- Investigated complex or high-value claims to identify discrepancies and fraud indicators.
- Compiled data from multiple sources for reporting purposes.
- Identified trends in rejected claims that could indicate system errors or fraudulent activity.
- Assessed and conducted negotiations within authority limits to settle claims.
Proximity Field Claims Specialist
State Farm Fire
Phoenix, AZ
12.2021 - 10.2022
- Handled and resolved claims through investigation, evaluation, and negotiation to expedite customer support.
- Processed and reviewed insurance claims to ensure accuracy and policy compliance.
- Reviewed and analyzed insurance claims to determine validity, completeness, accuracy, and eligibility for payment.
- Evaluated claim documentation to determine eligibility and coverage limits.
- Investigated complex claims to determine coverage and liability.
- Assessed and conducted negotiations within authority limits to settle claims.
- Built rapport with agents, contractors, public adjusters, and policyholders to achieve claim resolutions.
- Prepared and reviewed detailed estimates using Xactimate software
- Calculated and authorized payment of claims within specified limits.
- Processed and issued payments immediately following claim settlements
- Maintained detailed records of claim activities in management systems for tracking purposes.
- Trained new staff on claims processing systems and best practices for efficiency.
- Maintained knowledge of policies and procedures and insurance coverage benefit levels, eligibility systems and verification processes.
- Utilized claims software systems to manage and track claims progress.
- Communicated with clients and providers to clarify claim details and resolve issues.
- Provided customer service by responding promptly to inquiries regarding their coverage and going over their coverages.
- Pursued subrogation opportunities to recover costs and minimize financial loss for the organization.
- Collaborated with team members to streamline claims processing workflows and procedures.
- Monitored reports to identify claims issues and worked with adjusters to resolve problems.
- Collaborated with underwriting teams to provide insights on potential risks.
- Drafted statements of loss to summarize damages, payments and underlying policy coverages.
- Generated weekly reports summarizing progress made on active cases.
- Corresponded with insured or agent to obtain information or inform of account status or changes.
- Maintained up-to-date knowledge of regulatory changes affecting claims processing.
- Served as subject matter expert for non-standard coverage questions, property damage, and collision.
- Served as subject matter expert for non-standard coverage questions, property damage, and collision.
RA2 Property Complex Claim Specialist
State Farm Insurance Companies
Phoenix, AZ
04.2019 - 12.2021
- Resolved high volume of claims and calls while adhering to best claims handling practices
- Investigated and evaluated complex coverage and damage issues to facilitate resolution
- Ensured investigation integrity by reviewing files for accurate and relevant materials
- Comply with all compliance requirements for claims handling correspondence are met in a timely and professional manner
- Issue appropriate payments as per discretionary settlement
- Assess comparative negligence pursuant to specific state statutes
- Identify/Recognize NICB Indicators, recommend referral to SIU where appropriate
- Participated in the Employee Resource Group focused on Diversity & Inclusion initiatives
- Empower people by respecting and appreciating what makes them different, in terms of age, gender, ethnicity, religion, disability, sexual orientation, education, and national origin
Case Manager
Axis Health Systems
Durango, CO
11.2017 - 12.2018
- Identified client issues and developed targeted treatment goals
- Met with clients to evaluate their overall health
- Teach clients coping mechanisms
- Developed comprehensive aftercare plans for clients to ensure ongoing support.
- Refer clients to support groups and other needed medical care
- Provided comprehensive updates and progress reports to courts, probation officers, counselors, and primary care providers
- Met with families to offer guidance and support during treatment
Education
Bachelor of Science - Business Administration and Management
University of Phoenix
Lone Tree, COBusiness Technology Certification -
Clearfield Job Corps Center
Clearfield, UTHigh School Diploma -
Great Basin High
Clearfield, UTMulti State Adjusters License
NPN# 20196791Skills
- Claims Management
- Claims processing
- Claims assessment
- Claims investigations
- Claims negotiation
- Damage assessment
- Coverage analysis
- Claims Metrics
- Settlement determinations
- Compliance management
- Claims Analysis
- Xactimate proficiency
- Field Strategy
- Process Improvement
- Process optimization
- Reporting & Documentation
- Documentation review
- Inspection report review
- Accident investigations
- Critical thinking
- Risk evaluation
- Client Presentations
- Customer management
- Allocating claims
- Conflict resolution
- Team collaboration
- Collaboration
- Effective communication
- Skilled Communicator
- Adaptability
- Problem solving
- Microsoft office
- Estimate preparation
- Claims processing
- Settlement determinations
- Liability denials
- Documentation review
- Inspection report review
- Claims Analysis
Timeline
Weather Catastrophe Field Claim Specialist
State Farm Fire
10.2022 - 04.2026
Proximity Field Claims Specialist
State Farm Fire
12.2021 - 10.2022
RA2 Property Complex Claim Specialist
State Farm Insurance Companies
04.2019 - 12.2021
Case Manager
Axis Health Systems
11.2017 - 12.2018
Bachelor of Science - Business Administration and Management
University of Phoenix
Business Technology Certification -
Clearfield Job Corps Center
High School Diploma -
Great Basin High
Multi State Adjusters License