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, auto liability, tenders construction defect claims and pollution 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.
Overview
9
9
years of professional experience
1
1
Certification
Work History
Sr Claims Examiner Litigation
Crawford and Company
Remote
07.2024 - Current
- Investigates and resolves complex case load of 150+ litigated and non litigated bodily injury, auto premises and general liability 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.
- Reports claims to the excess carrier; responds to requests of directions in a professional and timely manner.
- Represents the company in client facing discussions and contribute to claim strategy development for accounts.
- Ensures claim files are properly documented by updating action plans every 30 to 90 days and claims coding is correct.
- Reviewed incoming tenders to determine if tendered claim should be accepted based on facts of loss, liability and contractual agreements.
- Mentored new hires on best practices and claims handling.
Claims Examiner
Sedgwick
Remote
08.2022 - 07.2024
- Managed high severity litigated and non litigated 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 in a timely matter.
- Determined if claim should be tendered to third party based on contractual agreements, facts of loss and liability.
- Negotiated settlements with claimants, attorneys, and adverse carriers, ensuring fair outcomes and regulatory compliance.
- Mentored new hires on best practices and claims handling.
Total Loss Adjuster
Liberty Mutual Insurance
Remote
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 attorney represented and non represented auto 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.
Skills
- Litigation Management
- Strong negotiation skills
- Coverage evaluation
- Policy interpretation
- Claims analysis
- Time management
Certification
Licensed in TX, AK, DE, FL, ID, IN, KY, LA, MN, MS, NH, OK, WY, NV, AZ, CN, MN, MI, OR, RI and SC
Timeline
Sr Claims Examiner Litigation
Crawford and Company
07.2024 - Current
Claims Examiner
Sedgwick
08.2022 - 07.2024
Total Loss Adjuster
Liberty Mutual Insurance
12.2021 - 08.2022
Telephone Claims Adjuster I&II
GEICO
06.2017 - 12.2021