Maria Kelly
Katy,TX
Summary
Seasoned Bodily Injury Insurance Specialist with excellent planning and problem solving abilities. Offering 20 years of experience and a willingness to take on any challenge. Organized, driven and adaptable professional with successful history managing high caseloads in fast-paced environments.
Overview
20
20
years of professional experience
Work History
Bodily Injury Claims Specialist
American Access Casualty
Katy, TX
06.2022 - Current
- Determine covered insurance losses by studying provisions of policies or certificates.
- Process claims with the utmost integrity, and timeliness.
- Evaluate, negotiate and settle bodily injury claims with unrepresented parties, and attorneys for represented injured parties.
- Handle 1st & 3rd party claims from soft tissue to fatality claims.
- TX licensed
- Handle PIP/ Med Pay / UMBI / UIM claims.
- Handle all liens to include, but not limited to workman's comp, Medicare/Medicaid, Child Support, and ERISA.
UM/ BI/ Commercial Auto Claims Representative
GEICO
Katy, TX
07.2004 - 06.2022
- Handle PIP/MED/ BI/ UM BI and Commercial Claims under first and third party coverage for attorney represented and unrepresented parties
- Conduct liability, coverage, injury, loss wages, loss of revenue and property damage investigations
- Thoroughly investigate all potentially fraudulent claims, and make the proper referrals to SIU if warranted
- Open proper exposures, set reserves, and issue payments
- Handle workman comp, Medicare/Medicaid, ERISA, hospital, and Child Support liens
- Familiar with claim handling processes & liability laws in MD, DE, DC, PA, WV, LA, MO, WI, and TX
- Experienced in customizations, motorcycle, commercial, & RV claims
- Experienced in subrogation, trained fellow associates in E-SUB hub processes, sent demands to adverse carriers, familiar with ARB Forums
- Coordinated and planned investigations of claims to confirm compensability and coverage.
- Conducted interviews with involved claims parties and witnesses to gather detailed information and arrange investigations.
- Researched and reviewed information to determine validity of insurance claims and contacted companies and customers about decisions.
- Examined automobile policies with third-party liability, accident benefits and collision benefits.
- Retained strong medical terminology understanding in effort to better comprehend procedures.
- Planned and conducted investigations of claims to confirm coverage and compensability.
- Investigated allegations of misconduct or negligence in relation to filed bodily injury claims.
- Assessed and conducted negotiations within authority limits to settle claims.
- Drafted letters to claimants regarding claim status or denials.
- Researched medical records, police reports, and other pertinent documents to determine liability.
- Identified potential fraud issues by analyzing claimant information and evidence from investigations.
- Provided excellent service and attention to customers when face-to-face or through phone conversations.
- Worked with cross-functional teams to achieve goals.
Education
The Institute, AICPCU
LoneStar College
GEICO University
Skills
- Claims Investigation
- Injury Evaluation
- Coverage Assessments
- Settlement Determinations
- Accident Investigations
- Insurance Knowledge
- Claims Processing
- Microsoft Office
- Data Entry
- Teamwork and Collaboration
- Client Interviews
- Customer Service
- Exceptional Recordkeeping Abilities
- Medicaid Knowledge
- Information Verification
- Organizing and Prioritizing Work
- Data Integrity
- Attention to Detail
- Medical Terminology
- Understanding of Medical Terms
- Insurance Terminology
- Critical Thinking
- Insurance Coverage Verification
Accomplishments
- Worked and settled the most BI/ UMBI claims on the floor in 2020 (263)
- Top closer on ESI team in Jan, Apr, May, Jul, and Aug 2019
- Named "Employee of the Month" March 2005, within eight months of being hired, for excellence in promoting the Auto Repair Express Program, always being a team player and assisting team members with their diaries.
- Promoted to CSR2 in 2006
- Received Chairman's Club in 2009, 2010, and 2011
- Promoted to CSR Coach/Trainer in March 2013.
- Promoted to TCR1 in October 2014
- Named TCR1 of the 2nd and 3rd Quarter 2015, after joining the department in March of 2015.
References
References available upon request.
Timeline
Bodily Injury Claims Specialist
American Access Casualty
06.2022 - Current
UM/ BI/ Commercial Auto Claims Representative
GEICO
07.2004 - 06.2022
The Institute, AICPCU
LoneStar College
GEICO University
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