Mellanie Gaymon
Suwanee,GA
Summary
Tactful Claims Specialist with expertise in settlement preparation, claims processing and appeal filing. Diplomatic and personable professional accustomed to handling sensitive, confidential information and investigating complex liability claims. Committed to maintaining customer satisfaction and contributing to company success.
Overview
16
16
years of professional experience
Work History
Insurance Claims Specialist
Crawford & Company
10.2019 - 04.2023
- Complied with company and insurance client’s guidelines in claims processes, assessing coverage, liability and damages closing of property claims and casualty. Commercial General Liability experience.
- Worked closely with counsel on litigated claims. Completed ROR letters, partial denial, full denial, and settlement letters.
- Issued payments in a prompt and timely manner. Assigned and followed up with field adjusters and other experts for work product necessary to conclude claims.
- Handled subrogation from other carriers.
- Coordinated rentals with rental vendors and customers or determining loss of use.
- Reviewed adjuster reports to ensure that claim file has sufficient documentation to justify all coverage and damage decisions.
- Worked professionally and provided empathy to clients while using effective communication and customer service skills.
Property Claims File Reviewer
United Property & Casualty Insurance
06.2016 - 10.2019
- Investigated, analyzed estimates, supplements, large loss claims for settlement.
- Negotiated settlements with insured, mitigation company, contractor and or Public Adjuster.
- Completed ROR letters, partial denial, full denial and settlement letters.
- Determine amount of property loss for appropriate settlement discussion with all parties involved.
- Experience with reconciliation,content inventory and ALE.
- Managed case load of over 100 claims.
Teacher
Gwinnett County Public School System
02.2007 - 05.2016
- Pursued professional development continually by attending educational conferences and teacher training workshops.
- Supported student teachers by mentoring on classroom management, lesson planning and activity organization.
- Worked collaboratively with other teachers to review data and develop instructional strategies to address student learning objectives.
- Prepared quizzes, tests and examinations to gauge how well students were learning.
- Observes and evaluated students’ performance, behavior, social development and physical health. Instructed up to 25 students individually and in groups.
- Planned and implemented creative lessons in accordance with district, county, state and federal guidelines.
- Used range of instructional approaches and classroom of activities to draw students into material and enhance understanding.
- Promoted student engagement with positive reinforcement techniques and diverse learning strategies.
- Developed and implemented classroom routines to address varying student needs.
- Assisted students of all ability levels to develop life- long learning skills and good study habits.
- Modified lessons and curriculum to accommodate diverse learners by using strategies such as peer-assisted learning and group work.
- Incorporated multiple types of teaching strategies into classroom.
- Developed and implemented classroom routines to address varying student needs
- Boosted cultural awareness by incorporating children's literature from world cultures
Education
Master of Science - Natural Sciences
Unversity of South Carolina
Columbia, SC05.2003
Skills
- Past Due Balance Management
- Fraud Detection
- Continuous Improvement
- Conflict Resolution Techniques
- Liability Denials
- Proficient with MSB software, Xactimate 28, MS Office Applications, and Lotus
- Handled claim with exposure up to $200,000
Timeline
Insurance Claims Specialist
Crawford & Company
10.2019 - 04.2023
Property Claims File Reviewer
United Property & Casualty Insurance
06.2016 - 10.2019
Teacher
Gwinnett County Public School System
02.2007 - 05.2016
Master of Science - Natural Sciences
Unversity of South Carolina
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