MARIAH BOWER

Claims Adjuster – Non-Standard Auto Insurance

• Investigated and resolved complex first- and third-party auto insurance claims while ensuring compliance with company guidelines and state regulations.
• Analyzed policy language to determine coverage eligibility and liability for reported losses.
• Policy not in force at the time of loss
• Lapse in coverage
• Vehicle not listed on the policy
• Driver not listed on the policy
• Material misrepresentation
• Misrepresentation during the application process
• Reviewed and processed policy rescissions and cancellations to ensure compliance with company standards.
• Resolved named insured disputes by analyzing documentation and communicating findings to stakeholders.
• Permissive use and excluded driver investigations
• Conducted ownership and insurable interest determinations to verify coverage eligibility and compliance.
• Reviewed underwriting documents, payment histories, endorsements, declarations pages, and policy changes to determine policy status and applicable coverage.
• Interpreted policy contracts, endorsements, exclusions, and state statutes to support accurate claim decisions.
• Collaborated with underwriting, special investigations, legal counsel, and management to resolve complex or potentially fraudulent claims, ensuring thorough investigation.
• Identified indicators of fraud and referred qualifying claims to the Special Investigations Unit (SIU) for further review.
• Communicated coverage determinations clearly, explaining policy provisions and denial decisions to insureds and claimants to enhance understanding.
• Prepared detailed claim documentation and maintained accurate file notes supporting investigative findings and coverage decisions.
• Negotiated claim resolutions when coverage applied and ensured timely, fair handling of all claims.
• Managed a high-volume caseload while meeting productivity and quality standards.
• De-escalated difficult customer interactions by providing empathetic communication while maintaining adherence to policy and regulatory requirements.
• Maintained strict confidentiality of customer information and ensured compliance with state insurance regulations and company standards.

• Identified and documented key details of each claim, building comprehensive case file for accurate decision-making.
• Verified and analyzed data used in settling claims to validate claims and settlements according to company practices and procedures.
• Investigated claims thoroughly, conducting interviews, reviewing policies, and analyzing evidence to determine coverage and liability.
• Interviewed or corresponded with agents and claimants to correct errors or omissions and to investigate questionable claims.
• Reviewed police reports, medical treatment records, medical bills, or physical property damage to determine extent of liability.
• Maintained detailed records of all claim activities in a computer system for accurate tracking purposes.
• Entered claim payments, reserves, and new claims on computer system, inputted concise yet sufficient file documentation.
• Demonstrated strong problem-solving skills when addressing challenging disputes between parties involved in a claim.
• Adjusted reserves and provided reserve recommendations to ensure that reserve activities were consistent with corporate policies.
• Responded to policyholder inquiries promptly and professionally, resolving concerns effectively.
• Managed caseloads efficiently while meeting tight deadlines without compromising quality standards.
• Reported overpayments, underpayments and other irregularities.
• Utilized various computer software programs and databases to complete claims analysis.
• Analyzed information gathered by investigation and report findings and recommendations.
• Managed high volume of claims while prioritizing urgent cases to ensure timely assistance during critical situations.
• Examined claim forms and other records to confirm coverage for loss or damage.
• Dedicated Claims Adjuster with 5+ years of experience in automobile claims handling.
• Skilled in policy investigations and utilizing CCC reports.
• Known for exceptional caseload management and resolving disputes effectively.
• Microsoft efficient with advanced communication abilities, ensuring prompt and accurate claim resolutions.

• Corresponded with witnesses, police, and physicians to determine claim settlement, denial, or review status.
• Communicated regularly with claimants via phone calls, emails or letters regarding status updates or additional documentation requests.
• Investigated, evaluated and settled claims, applying technical knowledge, and human relations skills to achieve fair and prompt disposal of cases and to contribute to reduced loss ratio.
• Auto claims day to day consist of answering emails, voicemails and handling auto accidents across the 50 states.
• Adjuster license certified to handle all states, set up inspections, make payments to customer and repair shops and general assisting files.
• Managed multiple customer requests simultaneously while maintaining high standards of service delivery.
• Provided excellent customer service to clients, responding promptly and professionally to all queries.
• Processed customer adjustments to maintain financial accounts.
• Followed up promptly on all unresolved cases from previous shifts.
• Adhered to relevant legislation and regulations pertaining to customer service activities.
• Developed strong relationships with customers by providing accurate information and assistance in a timely manner.
• Handled complex to low end liability claims.
• Day to Day handling customer requests via text, email, phone calls.
• Required knowledge of multiple systems CCC, Spi and other programs.
• Company was moving back into the office after working from home and after I had moved was no longer in the commute area.
• Handling all states, customer service skills required talking to customers after being in an accident handling First notice of loss claims, set up inspections for vehicle repairs, rental assignments.
• Ups tracking checking on customers deliveries and packages, handling service representatives and their international clients.

• Handling all states, customer service skills required talking tocustomers after being an in accident handling First notice of lossclaims, set up inspections for vehicle repairs, rental assignments.
• Processed auto claims efficiently using proprietary software and systems.
• Communicated with policyholders to gather necessary information for claims.
• Resolved customer inquiries regarding claims status and procedures promptly.

• Served customers in eating places that specialized in fast service and inexpensive carry-out food.
• Performed daily opening and closing procedures for restaurant operations.
• Kept work areas stocked with supplies and ingredients.
• Cleaned counters, cashier area and utensil display to comply with sanitary regulations.
• Brewed coffee and tea and filled containers with requested beverages.
• Reported accidents and injuries to supervisor to seek immediate solutions.
• Communicated with customers regarding orders, comments, and complaints.
• Performed cleaning duties such as sweeping, mopped and washing dishes, to keep equipment, and facilities sanitary.
• Followed safety procedures to prevent foodborne illness and allergens.
• Demonstrated proficiency in operating cash registers and point of sale systems.
• Inspected store displays regularly to ensure items were properly stocked and displayed according to company guidelines.
• Maintained adequate shift staffing levels to meet projected sales or expected customer levels.
• Organized eating, service, and kitchen areas.