MELANIE SADKOWSKI
Amherst
Summary
Service-oriented Claims Adjuster with 24 years of experience in evaluating complex claims and developing profitable processes. Strong skills in negotiation and conflict resolution enhance client satisfaction and ensure timely resolutions. Detailed understanding of the claims process and compliance with industry standards.
Overview
27
27
years of professional experience
Work History
Multi-Line Claims Adjuster
American National Insurance Company
Buffalo
10.2024 - Current
- Evaluated complex multi-line insurance claims, ensuring accuracy and compliance with industry standards.
- Analyzed documentation to identify liability and coverage issues, facilitating informed decision-making.
- Negotiated settlements with claimants or representatives on behalf of the company.
- Ensured adherence to state laws in adjusting multi-line claims, mitigating legal risks for the company.
- Analyzed policy provisions, endorsements, exclusions, state regulations and court decisions for determining claim liabilities.
Senior Claims Examiner
Sedgwick Insurance
10.2022 - 10.2024
- Negotiating settlement of claims within designated authority.
- Analyzed and processed claims using action plans to achieve timely resolutions by investigating and gathering information on claim exposure.
- Communicated claim activity and processing updates with claimants and clients to ensure transparency and understanding.
- Reported claims to the excess carrier and responded to requests for information promptly.
- Maintained contact with claimants and attorneys to track treatment status and facilitate claim progression.
- Worked with private investigators and attorneys on preparation of evidence, witness statements and other documentation in preparation for trial.
- Executed remote work tasks from a home office environment.
Multi-line Claims Adjuster
Merchants Insurance Group
02.2018 - 10.2022
- Delivered high-level customer service while managing portfolio of Commercial Auto and General Liability claims, including Auto Property Damage and Collision claims across NYNJ, PA, MA, and MI.
- Investigated coverage, liability, and damages while evaluating commercial 3rd party casualty claims.
- Conducts and directs timely and quality claim investigations, evaluations and equitable settlements of assigned claims.
- Cultivated relationships with claims and internal staff, policyholders, attorneys, agents, and service providers to achieve optimal outcomes for Merchants and policyholders.
- Ensured timely, accurate reserves aligned with reserve philosophy.
Senior Bodily Injury Adjuster
National General Insurance
08.2007 - 02.2018
- Handled bodily injury/liability auto and homeowner's claims, conducting initial investigations and facilitating first call settlements to expedite resolutions.
- Negotiated and settled property and injury claims, achieving fair outcomes for claimants and minimizing potential disputes.
- Conducted thorough medical evaluations to assess claim validity and treatment needs.
- Conducted detailed coverage analysis of personal automobile policies related to auto accidents, ensuring accurate claim assessments.
- Maintain contact with claimants and attorneys to determine treatment status.
- Communicate with internal and external customers by explaining the entire claims process.
Fault Claim Representative
Tower Group Companies
10.2003 - 08.2007
- Managed daily operations of high-volume claims desk, streamlining workflows for timely claim resolutions.
- Analyzed coverage under NYS No-Fault Regulation 68 to ensure compliance and accurate claims processing.
- Coordinated medical file management through peer reviews, Independent Medical Examinations, nurse case management, and accident reconstruction experts to support accurate claim assessments.
- Communicated coverage and timelines to policyholders and medical providers.
- Worked on several different computer systems to process claims efficiently/effectively.
- Participated in OneBeacon CAT team for homeowner property claims.
Licensed Claims Processor/Customer Service Associate
State Farm Insurance
08.1999 - 10.2003
- Initiated initial contacts with policyholders and claimants obtaining the facts of loss, injury information, property damage information, vehicle locations and lien holder information.
- Initiated the set-up of vehicle inspections and rentals.
- Managed a high volume of inquiries from customers, vendors, and co-workers while ensuring confidentiality.
Education
Bachelor of Arts - Psychology, Human Resources
The State University of New York
Buffalo, NYSkills
- New York license
- Florida license
- Texas license
- Analytical thinking
- Claims investigation
- Detail-oriented
- Results-driven
- Claims negotiation
Timeline
Multi-Line Claims Adjuster
American National Insurance Company
10.2024 - Current
Senior Claims Examiner
Sedgwick Insurance
10.2022 - 10.2024
Multi-line Claims Adjuster
Merchants Insurance Group
02.2018 - 10.2022
Senior Bodily Injury Adjuster
National General Insurance
08.2007 - 02.2018
Fault Claim Representative
Tower Group Companies
10.2003 - 08.2007
Licensed Claims Processor/Customer Service Associate
State Farm Insurance
08.1999 - 10.2003
Bachelor of Arts - Psychology, Human Resources
The State University of New York