Monique Charles
Houston
Summary
Detail oriented and results driven Claims Examiner with over 8 years of experience managing complex bodily injury and property damage claims under General Liability and Auto policies. Specialized in handling diverse exposures including premises liability, product liability, and construction defect claims. Proven expertise in coverage analysis, strategic reserving, negotiation, and settlement. Adept at managing litigated and non-litigated files, collaborating with legal counsel, and representing insurers in mediations, trials, and client review meetings. Recognized for reducing loss exposure through tactical resolution strategies and maintaining strict compliance with evolving insurance regulations.
Licensed in AK, DE, FL, ID, IN, KY, LA, MN, MS, NH, OK, WY, NV, AZ, CN, MN, MI, OR, RI and SC
Overview
8
8
years of professional experience
Work History
Sr Claims Examiner Litigation
Crawford and Company
07.2024 - Current
- Investigates and resolves complex case load of 150+ litigated and non litigated claims with a 94% or higher monthly compliance rate.
- Exercises independent judgment to evaluate coverage, determine liability, and set strategic reserves for moderate to severe exposures.
- Collaborates with defense counsel to prepare cases for litigation, mediations, and trial proceedings.
- Arranges appraisals, secures critical documentation, and negotiate equitable settlements in alignment with claims best practices.
- Represents the company in client facing discussions and contribute to claim strategy development for accounts.
- Mentors new hires by streamlining claims processing by implementing efficient workflow procedures.
Sr Claims Examiner
Sedgwick
08.2022 - 07.2024
- Managed high severity General Liability, Auto Liability, Product Liability and Premises Liability claims, including bodily injury and commercial auto exposures.
- Conducted thorough investigations, determine coverage, and recommend strategic reserves in order to resolve n a timely matter.
- Negotiated settlements with claimants, attorneys, and adverse carriers, ensuring fair outcomes and regulatory compliance.
- Prepared detailed reports for internal stakeholders and participate in claim review meetings with clients and partners.
- Collaborated with legal teams on litigated claims and attend mediations as needed.
- Mentored new hires on best practices and claims handling.
Total Loss Adjuster – Liberty Mutual
Liberty Mutual
12.2021 - 08.2022
- Handled total loss auto claims, determining actual cash value and negotiating settlements with insureds and third parties.
- Delivered consistent claim outcomes while managing a high-volume caseload across multiple jurisdictions.
- Maintained strong communication with policyholders and internal departments to ensure timely resolution.
Telephone Claims Adjuster I&II
GEICO
06.2017 - 12.2021
- Investigated and resolved complex liability claims involving bodily injury, property damage, and PIP/MedPay exposures.
- Drafted Reservation of Rights and denial letters in accordance with policy terms and state regulations.
- Coordinated with medical providers, attorneys, and insureds to assess damages and negotiate settlements.
- Supported litigation strategy and contributed to favorable outcomes in mediations and arbitration proceedings.
Education
Bachelor of Arts - Liberal Arts And Sciences
University of Houston
Houston, TXSkills
- Claims analysis
- Coverage evaluation
- Investigation techniques
- Policy interpretation
- Litigation management
- Knowable of insurance regulations
- Strong negotiation skills
Timeline
Sr Claims Examiner Litigation
Crawford and Company
07.2024 - Current
Sr Claims Examiner
Sedgwick
08.2022 - 07.2024
Total Loss Adjuster – Liberty Mutual
Liberty Mutual
12.2021 - 08.2022
Telephone Claims Adjuster I&II
GEICO
06.2017 - 12.2021
Bachelor of Arts - Liberal Arts And Sciences
University of Houston
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