Summary
Overview
Work History
Education
Skills
Timeline
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Nakeda Lindsey

Dallas,United States

Summary

Detail-oriented Injury Claims Specialist driven to resolve claims fairly while representing interests of employer. Conducts thorough and informed investigations, precisely evaluates losses and negotiates settlements that satisfy diverse parties. Builds and maintains professional and productive relationships and works to understand potentially conflicting points of view.

Overview

20
20
years of professional experience

Work History

Insurance Claims Specialist

Sea Harbor Insurnce
Dallas, TX
03.2023 - Current
  • Analyzed claim records, policy provisions, and other relevant documents to determine validity of claims.
  • Determined liability, compensability and benefits due on each claim.
  • Contacted injured parties and legal representatives to negotiate final settlements for claims.
  • Assessed and conducted negotiations within authority limits to settle claims.
  • Calculated benefit payments based on policy terms, coverage limits, and applicable regulations.
  • Ensured compliance with state laws governing insurance practices as well as company policies and procedures.
  • Coordinated with external parties such as lawyers, surveyors, appraisers during investigations.
  • Supported efficient handling of complex claims and followed up on open, denied or suspended claims to complete required line items.
  • Resolved claims by approving or denying documentation, calculating benefits due and determining compensation settlement.

Sorter Operations Associate

FedEx
Dallas, TX
01.2023 - Current
  • Scanned packages with RF scanner, sorted packages and palletized products according to warehouse or shipping destination.
  • Sorted incoming shipments and separated packages by size, type and destination within warehouse.
  • Communicated clearly and effectively with colleagues to facilitate workflow and troubleshoot issues needed.
  • Transported picked products to packing area and verified proper packaging, sealing and labeling.
  • Inspected items while sorting to meet criteria and maintain established rate per man hour.

Claims Adjuster

Government Employees Insurance Company
Richards, TX
11.2003 - 08.2023
  • Reviewed, evaluated and adjusted claims to promote fair and prompt settlement.
  • Negotiated and settled claims according to information presented through reports, research and data verification.
  • Investigated questionable claims to determine payment authorization.
  • Obtained necessary information to complete proper evaluation of injury claims.
  • Reviewed data to verify validity of claims and determine case management actions.
  • Coordinated benefits while applying applicable deductibles, co-insurance and out-of-pocket costs.
  • Drafted statement of loss to summarize damages, payments and underlying policy coverage.
  • Conducted witness interviews to assist claim information gathering process.
  • Identified and collected evidence and determined value to specific claim to properly assess conditions.
  • Reduced loss ratios through fair and prompt processing of claims.
  • Interviewed claimants, medical specialists and employers to determine pertinent claim information.

Education

High School Diploma -

Skyline High School
Dallas, TX
06.1995

Some College (No Degree) - Business Administration And Management

Cedar Valley College
Lancaster, TX

Skills

  • Policy Interpretation
  • Documentation Review
  • Coverage Assessments
  • Settlement Determinations
  • Compliance Management
  • Allocating Claims
  • Claim Amount Calculations
  • Eligibility Determination
  • Decision-Making
  • Policy Review

Timeline

Insurance Claims Specialist

Sea Harbor Insurnce
03.2023 - Current

Sorter Operations Associate

FedEx
01.2023 - Current

Claims Adjuster

Government Employees Insurance Company
11.2003 - 08.2023

High School Diploma -

Skyline High School

Some College (No Degree) - Business Administration And Management

Cedar Valley College

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Nakeda Lindsey