Melanie Bagsby
Mobile,AL
Summary
Experienced licensed Claims Adjuster, versed in investigating claims, verifying information and managing settlements. Organized and driven with excellent planning and problem-solving abilities. Known for reliability and adaptability, with swift capacity to learn and apply new skills. Committed to leveraging these qualities to drive team success and contribute to organizational growth.
Overview
4
4
years of professional experience
Work History
Claims Representative
PURE Insurance
12.2023 - Current
- Worked productively in fast-moving work environment to process large volumes of claims.
- Followed up with customers on unresolved issues.
- Maintained compliance with industry regulations by adhering to established procedures and guidelines in claims handling.
- Enhanced claim processing efficiency by streamlining workflows and implementing best practices.
- Investigated accidents or incidents to determine cause and extent of damages.
- Achieved high customer satisfaction ratings by providing clear and timely communication throughout claims processing.
- Reduced turnaround time for claim settlements by prioritizing tasks and managing deadlines effectively.
- Collaborated with internal departments and external vendors to resolve claims.
- Handled both first party and third party claims under multiple policy types and numerous endorsements.
- Managed high-volume caseloads to ensure rapid resolution for clients and maintained customer satisfaction levels.
- Review and submit decisions on arbitration hearings.
- Reviewed police reports and/or physical property damage to determine extent of liability.
- Interviewed or corresponded with claimants and witnesses to determine claim settlement, denial, or review.
Auto Desk Adjuster
Sedgwick
12.2022 - 10.2023
- Balanced competing priorities in a fast-paced environment, ensuring timely completion of all assigned tasks without compromising quality or attention to detail.
- Handled both first party and third party claims under multiple policy types and numerous endorsements.
- Provided quality customer service to assigned insureds and claimants throughout claims process to deliver timely service.
- Assessed damages to properties.
- Reviewed, evaluated and adjusted claims to promote fair and prompt settlement.
- Negotiated and settled claims according to information presented through reports, research and data verification.
- Drafted statement of loss to summarize damages, payments and underlying policy coverage
- Obtained necessary information to complete proper evaluation of subrogation and total loss claims.
- Verified liability extent with reviews of police reports, medical treatment histories and other records.
- Reviewed policies to determine appropriate levels of coverage and assist with approval or denial decisions.
Claims Adjuster (CAT)
Eberls Claims Service
09.2022 - 12.2022
- Examined claims forms and other records to determine insurance coverage.
- Maintained compliance with state regulatory requirements through meticulous documentation and adherence to company policies.
- Researched and analyzed policy contracts to verify proper payment of claims.
- Conducted thorough investigations of complex insurance claims, gathering evidence and analyzing relevant documentation.
- Explained loss coverage, assisted policyholders with itemizing damages and coordinated alternative living arrangements.
- Coordinated emergency repair, cleaning companies and contractors to optimize customer claim handling.
- Investigated properties, classified damages and created estimates outlining repair costs.
- Managed catastrophic loss events effectively by coordinating rapid response efforts and providing support to impacted policyholders.
Property Desk Adjuster
Cross Country Adjusting
08.2022 - 11.2022
- Assisted clients in understanding complex insurance terms and coverage options, effectively addressing their concerns and guiding them through the claims process.
- Collaborated with other adjusters, contractors, and appraisers to effectively coordinate property inspections and repair efforts.
- Demonstrated adaptability by managing various types of property claims, ranging from minor residential damages to large-scale commercial losses.
- Negotiated fair settlements by carefully analyzing repair cost estimates and maintaining open lines of communication with all parties involved.
- Conducted thorough investigations of reported losses, gathering essential information from policyholders to accurately determine coverage eligibility.
- Provided exceptional customer service while handling sensitive situations involving property damage and loss.
- Managed a high volume of claims, prioritizing cases based on urgency and complexity to ensure timely resolution.
- Used Xactimate to compile estimates for personal property and structure damage.
- Investigated and assessed damage to property and reviewed property damage estimates.
- Assisted homeowners by coordinating vendor services, emergency repair, cleaning and contractors.
Claims Adjuster/ File Reviewer/ QA
Sedgwick
07.2021 - 08.2022
- Researched and analyzed policy contracts to verify proper payment of claims.
- Conducted thorough investigations of complex insurance claims, gathering evidence and analyzing relevant documentation.
- Prepared summaries of damage, payments, and policy coverage.
- Conducted comprehensive interviews of witnesses and claimants to gather facts and information.
- Provided exceptional customer service during emotionally difficult situations for policyholders following accidents or natural disasters.
- Resolved complex, severe exposure claims using high service oriented file handling
- Investigated, evaluated and settled claims by applying technical knowledge and human relations skills to achieve fair and prompt disposal of cases and to contribute to reduced loss ratio.
Desk Adjuster
Alacrity Solutions
04.2021 - 08.2021
- Examined claims forms and other records to determine insurance coverage.
- Adhered to company and insurance client's guidelines in claims processes, estimate writing and claim closures.
- Determined insurance coverage levels and restrictions by thoroughly examining claims forms and associated records.
- Determined coverage and liability decisions based on conclusions of the investigation; including but limited too recorded statements, securing public records and analyzing report findings.
- Processed payments within designated authority level .
- Reviewed and compared estimates when issuing supplements.
Field Claims Adjuster
Pilot Catastrophe Services
12.2020 - 04.2021
- Conducted interviews, gathered detailed information and completed field investigations.
- Provided clear explanations to clients regarding complex policy terms, ensuring they felt informed and confident throughout the claims process.
- Investigated properties, classified damages and created estimates outlining repair costs.
- Determined insurance coverage levels and restrictions by thoroughly examining claims forms and associated records.
- Use advanced video technology to collaborate with onsite vendors to identify damages and write a contents damage estimate from a virtual setting.
- Explained loss coverage, assisted policyholders with itemizing damages and coordinated alternative living arrangements.
- Traveled to customer sites to evaluate fallen trees, leaking roofs and other issues to create accurate cost estimations.
- Conducted day-to-day administrative tasks to maintain information files and process paperwork.
Education
Master of Science - Public Health
Argosy University
Atlanta, GA11.2013
Bachelor of Science - Recreational Therapy
Alabama State University
Montgomery, AL 07.2008
Associate of Science - Biology
Bishop State Community College
Mobile, AL 05.2006
Skills
- Claims Investigation
- Customer Service
- Critical Thinking
- Organizing and Prioritizing Work
- General Liability
- Strategic Planning
- Property & Casualty
- Total Loss
- Symbility
- Xactimate
- Guidewire
- Proficient in Microsoft Office (Word, Power Point, Excel, Outlook)
Licenses
NPN #19729618
ALABAMA - 3001398187
TEXAS - 2604684
LOUISIANA - 939506
FLORIDA - W765698
MISSISSIPPI - 10791150
MICHIGAN - 1018507
GEORGIA - 3476422
MONTANA - 3001105713
MINNESOTA - 40716542
SOUTH CAROLINA - 19729618
KENTUCKY - 1180141
CONNECTICUT - 19729618
*CALIFORNIA - 4196457
*NEW YORK - 1729847
Timeline
Claims Representative
PURE Insurance
12.2023 - Current
Auto Desk Adjuster
Sedgwick
12.2022 - 10.2023
Claims Adjuster (CAT)
Eberls Claims Service
09.2022 - 12.2022
Property Desk Adjuster
Cross Country Adjusting
08.2022 - 11.2022
Claims Adjuster/ File Reviewer/ QA
Sedgwick
07.2021 - 08.2022
Desk Adjuster
Alacrity Solutions
04.2021 - 08.2021
Field Claims Adjuster
Pilot Catastrophe Services
12.2020 - 04.2021
Master of Science - Public Health
Argosy University
Bachelor of Science - Recreational Therapy
Alabama State University
Associate of Science - Biology
Bishop State Community College
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