Navy Bernard
Property Insurance Claims Adjuster
Las Vegas,NV
Summary
Observant Property Supervisor and Team Lead Adjuster with over 6 years of comprehensive experience investigating claims, as a Subrogation Investigator, in QA/QC Claims Examiner, and Environmental in Properties and Automobiles.
Service-oriented Claims Adjuster skilled at applying creative approaches to solving complex problems. Adept at developing profitable and quality-focused processes. Results-oriented Claims Adjuster bringing hands-on law enforcement experience and exceptional leadership and communication skills. Background includes criminal investigation, insurance fraud and risk management.
Overview
8
8
years of professional experience
Work History
Senior Property Insurance Claims
MidAmerica Claims (Olympus Insurance Claims)
Mobile, AL
10.2022 - 01.2023
- Identified insurance coverage limitations with thorough examinations of claims documentation and related records.
- Conducted thorough property investigations to identify and classify damages for customer claims.
- Collected and tracked evidence in support of legal processes.
- Reviewed and analyzed suspicious and potentially fraudulent insurance claims.
- Followed up with insured individuals regarding premium and deductibles payments.
- Examined claims forms and other records to determine insurance coverage.
- Reviewed questionable claims by conducting agent and claimant interviews to correct omissions and errors.
- Resolved complex, severe exposure claims using high service oriented file handling.
- Negotiated and payout settlement agreements to resolve open claims.
- Helped train on new adjusters with claims systems and multiple claims disputed calls.
Subrogation Auto Investigator
Crawford (Geico, Infinity & Kemper Autos)
Maurice, IA
02.2022 - 08.2022
- Implemented improvements in manual and electronic billing procedures.
- Collected and tracked evidence in support of legal processes.
- Synthesized data into comprehensive quarterly written reports for management.
- Worked with attorneys, and internal or external claimants to resolve claims
•Evaluated cases for the final course of action based on facts of loss
•Collected back deductibles and out of pocket expenses from at-fault carriers
•Handled outbound and inbound calls from uninsured parties to make recoveries
•Located adverse parties via skip tracing system, crash auto systems
•Documented claim accordingly and complete proper Subrogation demand letters to the adverse parties
•Discussed liability with claimant carriers and negotiated final settlements - Identified insurance coverage limitations with thorough examinations of claims documentation and related records.
- Evaluated original investigation reports and documents to resolve secondary concerns.
- Conducted full claim investigations and reported updates and legal actions.
- Escalated files with significant indemnity exposure to supervisor for further investigation.
- Conducted comprehensive interviews of witnesses and claimants to gather facts and information.
- Collected evidence to support contested claims in court.
- Reviewed police reports, medical treatment records and physical property damage to determine extent of liability.
- Located adverse parties via skip tracing system, crash auto systems
- Documented claim accordingly and complete proper Subrogation demand letters to the adverse parties.
- Discussed liability with claimant carriers and negotiated final settlements
Property Insurance Adjuster
MidAmerica Claims (FedNet)
Mobile, AL
07.2021 - 02.2022
- Examined claims forms and other records to determine insurance coverage.
- Reviewed police reports, medical treatment records and physical property damage to determine extent of liability.
- Collected and tracked evidence in support of legal processes.
- Conducted thorough property investigations to identify and classify damages for customer claims.
- Interviewed agents and claimants to correct errors or omissions and investigate questionable claims.
- Identified insurance coverage limitations with thorough examinations of claims documentation and related records.
- Evaluated original investigation reports and documents to resolve secondary concerns.
- Followed up with insured individuals regarding premium and deductibles payments.
- Investigated claims involving potential and suspected fraudulent activities.
- Maintained contact with claimants and attorneys to determine treatment status.
- Prepared summaries of damage, payments and policy coverage.
Independent Property Claims Adjuster
Allied Trust Claims
Tampa, FL
12.2020 - 07.2021
- Investigated claims by reviewing policy contracts to determine claim coverage based on cause and facts of loss.
- Carefully reviewed claim information to verify accuracy and avert fraudulent claims.
- Reviewed and analyzed suspicious and potentially fraudulent insurance claims.
- Reviewed new files to determine current status of injury claim and to develop plan of action.
- Identified insurance coverage limitations with thorough examinations of claims documentation and related records.
- Evaluated original investigation reports and documents to resolve secondary concerns.
- Followed up with insured individuals regarding premium and deductibles payments.
- Conducted thorough property investigations to identify and classify damages for customer claims.
- Analyzed information gathered by investigation and report findings and recommendations.
- Clarified coverage of losses to policyholders and provided assistance in itemizing damages and finding alternative living arrangements.
- Investigated and assessed damage to property and reviewed property damage estimates.
- Resolved complex, severe exposure claims using high service oriented file handling.
- Collaborated with contractors, technicians, and vendors on complex losses to come to equitable and accurate.
- Investigated, determined coverage on, and settled personal lines property claims in accordance with state and federal of Insurance regulations.
Supervisor Insurance Claims Environmental
Global Risk Solutions
Port Neches, TX
11.2019 - 08.2020
- Supervised a team of 40 Evacuation Insurance Adjusters in a fast-paced collaborative environment
- Approved claim payments and settlements based on information collected from customers and contractors and issues payments to policyholders where possible.
- Explained coverage of the loss, and assists policyholders with itemization of damages, emergency repairs, and additional living arrangements.
- Quality control incoming property settlements investigates, determines coverage of loss and adjusts all elements of routine Property Loss claims.
- Investigated property liens, the release of liens, warranty deeds, affidavit of no lien, and affidavit of no insurance.
- Investigated TPC property damages, property settlements, and certification of self-repairs.
- Assigned workloads, maintained performance management and reviewed daily activity reports.
- Evaluated employee performance and recommended promotions, transfers and dismissals.
- Carried out day-to-day duties accurately and efficiently.
- Offered friendly and efficient service to customers, handled challenging situations with ease.
- Completed paperwork, recognizing discrepancies and promptly addressing for resolution.
- Monitored priorities and liaised between property team and management, delegating tasks to complete on time.
Subrogation Property Environmental
Worley Claims Services LLC
Hammond, LA
08.2018 - 10.2019
- Evaluated original investigation reports and documents to resolve secondary concerns.
- Reviewed new claims to determine status of subrogation potential and to develop a plan of action. adjuster's reports and estimates for accuracy.
- Investigated and settled complex environmental subrogation claims with estimated large losses.
- Responsible for the fair and accurate disposition of complex homeowner property claims by determining coverage, applying policy terms and conditions, determining damages, and negotiating settlements.
- Evaluated all evidence with the goal of creating positive outcomes for our client's claims.
- Reviewed claims filed for approval and payment to the insureds • Evaluated insurance policies and analyzed damages to determine coverage as it pertained to subrogation. • Reviewed and analyzed suspicious and potentially fraudulent insurance claims.
- Negotiates and settled adverse subrogation and issues settlement checks and payments. • Prepared subrogation demand packages and restitution proposals.
- Established productive working relationships with attorneys, property, and field adjusters.
- Determined liability outlined in coverage and assessed documentation such from police and healthcare providers to understand damages incurred.
- Prepares settlement letters, denial letters, Reservation of Rights, and other letters needed.
- Settlements and concise diary notes, uses the Special Handling area, sets field assignments, sets and saves contacts, and makes payments.
Recognizes the need for SIU involvement and identifies files for potential subrogation. - Appropriately applies knowledge of multiple state statutes, including the insurance code of ethics, rules, regulations, and guidelines.
- Determines whether a file has a valid Assignment of Benefits and handles accordingly.
- Effectively handles difficult calls from customers, attorneys, public adjusters, vendors, and others and sets mediation or appraisal when needed.
- Reviewed and analyzed suspicious and potentially fraudulent insurance claims.
- Collected and tracked evidence in support of legal processes.
Property Claims Examiner
USAA
San Antonio, TX
06.2016 - 07.2018
- Examined claims forms and other records to determine insurance coverage.
- Interviewed agents and claimants to correct errors or omissions and investigate questionable claims.
- Maintained suspicious claims database and prepared reports for supervisors.
- Analyze claims to determine the extent of the company's liability and make approval or denial decisions.
- Handled and negotiated settlements with claimants in accordance with policy provisions.
- Collaborate with insurance agents and interview claimants to correct errors, rectify omissions, and investigate questionable issues.
- Prepared summaries of damage, payments and policy coverage.
- Placing outbound calls to claimants and gathering more information on Peril's determination.
- Reviewed HO3, HO6, HO5, and DP3 Declaration coverages.
- Evaluated evidence with ultimate goal of creating positive outcomes for client's claims.
- Collaborated with claims department and industry anti-fraud organizations to resolve claims.
- Evaluated insurance policies and analyzed damages to determine coverage.
- Analyzed information gathered by investigations to report findings and recommendations.
- Investigated and assessed damage to property and reviewed property damage estimates.
- Reviewed field inspections and coordinated all insurance claim audits.
Mortgage Compliance Analyst
USAA
San Antonio, TX
06.2014 - 07.2016
- Managed VA, Fannie Mae, FHA, Conventional loan files for completeness and accuracy and compliance through the Salesforce system.
- Managed mortgage applications, credit history, and income documents, title documents.
- Assessed compliance with HMDA, CRA, RESPA, GFE, TILA, ECOA, FACTA, and state regulations.
- Reviewed and evaluated borrower (s) profile including but not limited to all income documents and tax returns.
Maintain preliminary reports, judgments', bankruptcy, and appraisals with A completed statement of credit denial notices and withdrawn loans. - Identified portfolio risks resulting from the client's underlying business practices, underwriting, and/or fraud exposure.
- Evaluated debt ratio, loan-to-value ratios, credit score, property valuation, and various other factors.
- Audited and initiated underwriting for quality, and ensure compliance, accuracy, and completeness of loan per guidelines.
- Performed accurate review of real estate loans using specific guidelines to determine whether a loan was underwritten in accordance with underwriting guidelines.
- Performed Adverse Action reviews of applications Ease, prior to the closing loan.
- Scrubbed, Audited EHMDA LAR updating with findings.
- Worked within applicable standards, policies and regulatory guidelines to promote safe working environment.
- Completed paperwork, recognizing discrepancies and promptly addressing for resolution.
- Prepared variety of different written communications, reports and documents.
- Created spreadsheets using Microsoft Excel for daily, weekly and monthly reporting.
Education
Management Courses
Lamar Institue
Beaumont TexasManagement Courses
Brown Mackie
San Antonio, TXSkills
Supervisor & Team Lead with risk management
QA & QC Skills
Aduditor with strong motivator
Subrogation expert
Claims Investigator
Coverage determination
Negotiation and mediation skills
Risk management with collaboration
Extensive in analysis & evaluation
Compliance & development
Comprehensive & effectiveness
Fulfillment with organization
Compliance with customer service
Development and compromised settlements
Timeline
Senior Property Insurance Claims
MidAmerica Claims (Olympus Insurance Claims)
10.2022 - 01.2023
Subrogation Auto Investigator
Crawford (Geico, Infinity & Kemper Autos)
02.2022 - 08.2022
Property Insurance Adjuster
MidAmerica Claims (FedNet)
07.2021 - 02.2022
Independent Property Claims Adjuster
Allied Trust Claims
12.2020 - 07.2021
Supervisor Insurance Claims Environmental
Global Risk Solutions
11.2019 - 08.2020
Subrogation Property Environmental
Worley Claims Services LLC
08.2018 - 10.2019
Property Claims Examiner
USAA
06.2016 - 07.2018
Mortgage Compliance Analyst
USAA
06.2014 - 07.2016
Management Courses
Lamar Institue
Management Courses
Brown Mackie