Summary
Overview
Work History
Education
Skills
Certification
Timeline
Generic

Mandy Esrock

Fairfield,CA

Summary

Experienced Senior Field Large Loss Claims Specialist with a proven track record in managing complex insurance claims and policy processing. Proficient in using insurance software and estimating programs, with a keen ability to interpret policies and resolve claims to the satisfaction of all parties. Demonstrates exceptional problem-solving skills and a commitment to improving efficiency and customer service in claims processing.

Overview

23
23
years of professional experience
1
1
Certification

Work History

Senior Field Large Loss Claims Specialist, III

LIBERTY MUTUAL INSURANCE COMPANY
Dover, New Hampshire
04.2018 - Current
  • Analyzed insurance claims for payment eligibility based on validity and accuracy.
  • Investigated complex or high-value claims to identify discrepancies and fraud indicators.
  • Processed payments for valid claims according to established procedures.
  • Served as the key liaison among claimants, attorneys, and adjusters to facilitate smooth claim resolution."
  • Assisted with filing appeals on denied claims with insurance companies.
  • Compiled data from multiple sources for reporting purposes.
  • Interpreted legal documents related to claims processing such as contracts and policy language.
  • Maintained detailed records of all claim activities including notes about conversations with claimants or representatives.
  • Provided customer service by responding promptly to inquiries from claimants regarding their benefits or coverage.
  • Conducted regular audits to uphold documentation accuracy and regulatory compliance.Analyzed settlement offers against liability limits set by insurers.
  • Advised management on potential changes needed in policies or procedures based on findings from investigations.
  • Collaborated with other departments within the organization to resolve issues related to claims processing.
  • Performed quality assurance reviews on new hires' work product.
  • Developed training materials for staff members on best practices for handling different types of claims.
  • Created detailed weekly progress reports on active claims cases..
  • Engaged in ongoing education to stay abreast of industry standards and best practices.
  • Maintained knowledge of policies and procedures and insurance coverage benefit levels, eligibility systems and verification processes.
  • Communicated with other departments to establish action plans and manage open claims to closure.
  • Resolved claims by approving or denying documentation, calculating benefits due and determining compensation settlement.
  • Assessed and conducted negotiations within authority limits to settle claims.
  • Researched and reviewed information to determine validity of insurance claims and contacted companies and customers about decisions.
  • Determined covered insurance losses by studying provisions of policies or certificates.
  • Drafted statements of loss to summarize damages, payments and underlying policy coverages.
  • Inspect properties to establish loss related damages, create reconstruction property estimate, negotiation and reach and agreed upon scope and cost of loss related damages with property owner and/or contractor.

Weather/Catastrophe Insurance Adjuster

State Farm Insurance
Bloomington, Illinois
06.2001 - 04.2018
  • Conducted on-site inspections of damaged properties to assess the extent of damage and estimate repair costs.
  • Reviewed policy documents to determine coverage and potential liability for claims.
  • Evaluated customer complaints, submitted evidence and determined appropriate resolution options.
  • Negotiated settlements with claimants in accordance with company guidelines.
  • Coordinated with other professionals such as attorneys, appraisers and contractors during the claims process.
  • Collaborated with adjusters from other companies to resolve intercompany disputes over claims responsibility or payment amounts.
  • Attended meetings with policyholders, attorneys, contractors and other stakeholders involved in catastrophic events.
  • Assessed the need for temporary housing arrangements while permanent residences are being restored after a disaster.
  • Oversee training of new hires and help develop company training procedures and guidelines.
  • Participate in inter-company arbitration forums.

Education

MBM - Business Administration And Management

University of Phoenix
Tempe, AZ
04-2010

Skills

  • Compliance Management
  • Policy Interpretation
  • Complex negotiation and litigation
  • Large loss property assessment
  • Symbility & Xactimate Fluent
  • Settlement determinations
  • Coverage assessments
  • Property damage estimate preparation
  • New hire training
  • Catastrophe handling and assessment
  • DEI lead
  • Verbal Communication
  • Claims Investigation
  • Microsoft Office
  • Teamwork and Collaboration
  • Insurance Coverage Verification
  • Adaptability
  • Self Motivation
  • Data Integrity
  • Regulatory compliance understanding
  • Payment and Investigation Escalations
  • Computer Proficiency
  • Effective Communication

Certification

  • California Earthquake Certified
  • Multi-State Adjuster Licensed

Timeline

Senior Field Large Loss Claims Specialist, III

LIBERTY MUTUAL INSURANCE COMPANY
04.2018 - Current

Weather/Catastrophe Insurance Adjuster

State Farm Insurance
06.2001 - 04.2018

MBM - Business Administration And Management

University of Phoenix

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