Monica Niles
Oneonta,NY
Summary
Results-driven Claims Experience Specialist with strong leadership, coaching and mentoring expertise. Skilled in developing team skills in customer-focused communication, negotiation and critical thinking. Proven ability to guide examiners through complex claims scenarios, improve performance metrics and strengthen overall experience quality. Committed to building collaborative, high performing teams that deliver consistent and positive outcomes.
Overview
11
11
years of professional experience
Work History
Claims Experience Specialist (Property/Commercial)
Nycm Insurance
05.2021 - Current
- Scored written and oral communication between claims personnel and customers.
- Coached and mentored claims examiners and field adjusters on their claim handling and customer interactions.
- Monitored and provided feedback on cNPS and claims trends.
- Answered all DFS, BBB and agency complaints regarding first and third party homeowner and commercial property damage claims.
- Trained new and existing claims examiners and field adjusters on positive customer experience interactions.
- Work closely with Property Team Leadership on initiatives and KSTs and provided feedback for employee reviews.
Liability Claims Representative
Preferred Mutual Insurance
09.2016 - 05.2021
- Investigated and determined coverage and liability for bodily injury and property damage claims under personal and commercial policies in multiple states.
- Evaluated medical records and adjuster reports, utilizing information to negotiate fair settlement with claimants and attorneys.
- Worked independentally to settle claims within authority.
- Assist in developing strategies with defense counsel in litigated cases, attending depositions, mediations and arbitrations when necessary.
- Acted as "claim lead" which included: Onboarding/training/mentoring new hires; facilitated and attended trainings and team meetings; reviewed and assigned every 3rd party claim, providing direction within department; tracked and assigned suits; Reviewed and circulated large loss reports to senior leadership; acted as liaison within other claims departments.
Auto Claims Representative
Preferred Mutual Insurance
03.2015 - 09.2016
- Investigated and determined coverage and liability for first and third party auto physical damage claims in a timely manner.
- Familiarized with personal and commercial auto policies in multiple states.
- Negotiate settlement with insureds and claimants for both repairable and total loss vehicles.
- Assisted in training new hires on multiple systems and procedures.
Education
Bachelor of Science - Psychology
SUNY, Oneonta
Oneonta, NY12-2009
Skills
- Customer experience oriented
- Effective team leadership
- Excellent written and oral communication
- Training and evaluation
- Critical thinking abilities
- Interpersonal communication and conflict management
- Proficient desk management
Timeline
Claims Experience Specialist (Property/Commercial)
Nycm Insurance
05.2021 - Current
Liability Claims Representative
Preferred Mutual Insurance
09.2016 - 05.2021
Auto Claims Representative
Preferred Mutual Insurance
03.2015 - 09.2016
Bachelor of Science - Psychology
SUNY, Oneonta
Leadership Otsego, 2025
Leadership Otsego is an six-month interactive program for current and emerging leaders in the community. I participated with a chosen group of individuals to address challenging issues in our county.