Nebiat Shibeshi
Dallas,TX
Summary
Seasoned Bodily Injury Claims Specialist recognized for high productivity and efficiency in task completion. Skilled in claims analysis, negotiation, and settlement processes. Possess strong abilities in critical thinking, problem-solving, and decision-making to navigate complex cases. Excel at communication and empathy, ensuring clear understanding and support for all parties involved.
Overview
10
10
years of professional experience
Work History
Bodily Injury Claims Specialist
State Farm
Dallas, TX
11.2022 - Current
- Investigated bodily injury claims and determined coverage eligibility.
- Assessed medical records, witness statements, and police reports to evaluate liability.
- Negotiated settlements with claimants and attorneys.
- Resolved complex bodily injury cases involving multiple parties.
- Reviewed insurance policies for applicable coverage limits and exclusions.
- Prepared detailed documentation outlining claim decisions, actions taken, and rationale for settlement amounts.
- Provided timely updates to policyholders regarding their claim status.
- Maintained accurate records of all claim files, including documents related to claim resolution activities.
- Advised management on strategies for mitigating losses associated with bodily injuries.
- Collaborated with outside vendors such as adjusters, investigators, and lawyers throughout the claims process.
- Participated in regular meetings with senior leadership to discuss progress towards departmental goals.
- Ensured compliance with state laws governing the handling of personal injury cases.
- Provided guidance and support to junior staff members when needed during difficult cases.
- Determined liability, compensability, and benefits due on each claim.
- Supported efficient handling of complex claims and followed up on open, denied, or suspended claims to complete required line items.
- Assisted claimants, providers and clients with problems or questions regarding claims.
- Called insurance companies to ascertain pertinent information regarding policies and payment benefits for patients.
- Corresponded with insured or agent to obtain information or inform of account status or changes.
Claims Specialist
GEICO
Dallas, TX
03.2022 - 11.2022
- Reviewed and analyzed insurance claims to determine validity, completeness, accuracy, and eligibility for payment.
- Investigated complex or high-value claims to identify discrepancies and fraud indicators.
- Processed payments for valid claims according to established procedures.
- Facilitated communication between claimants, providers, attorneys, adjusters, employers, and other parties involved in a claim.
- Maintained detailed records of all claim activities including notes about conversations with claimants or representatives.
- Provided customer service by responding promptly to inquiries from claimants regarding their benefits or coverage.
- Maintained knowledge of policies and procedures and insurance coverage benefit levels, eligibility systems and verification processes.
- Planned and conducted investigations of claims to confirm coverage and compensability.
- Researched and reviewed information to determine validity of insurance claims and contacted companies and customers about decisions.
- Conducted interviews with involved claims parties and witnesses to gather detailed information and arrange investigations.
- Negotiated settlements with claimants and attorneys within authorized limits.
- Maintained up-to-date knowledge of insurance laws and regulations.
- Provided exceptional customer service to maintain positive relationships with all parties.
- Reviewed and processed insurance claims to ensure accurate and timely resolution.
Banker
Bank of America
San Diego, California
10.2014 - 03.2022
- Provided customer service to bank clients, answering inquiries and resolving complaints.
- Developed financial plans for customers based on their individual needs.
- Advised customers on various banking products and services such as loans, investments, and credit cards.
- Analyzed customer's financial information to determine the best banking products for them.
- Monitored changes in regulations affecting banks and updated policies accordingly.
- Verified customer identity using government-issued identification documents.
- Investigated fraudulent activities by analyzing account transactions and identifying suspicious patterns.
- Maintained accurate records of all transactions within the branch's database system.
- Assisted with onboarding new employees by training them on banking procedures.
- Coordinated with other departments regarding customer requests or disputes resolution.
- Helped customers open and close accounts, apply for loans and make sound financial decisions.
- Assisted customers by answering banking questions and recommending solutions.
- Helped customers understand and use mobile applications and online banking.
- Modified, opened and closed customer accounts.
- Trained and coached less experienced team members in procedures, compliance standards and performance strategies.
- Completed daily cash balancing and operated ATMs.
- Reconciled cash and checks against computer records at end of shift.
Education
Bachelor of Arts - Business Management
Alpha University College
Addis Ababa, Ethiopia 06-2011
Skills
- Bodily Injury evaluation
- Policy Interpretation
- Insurance knowledge
- Customer Service
- Teamwork and collaboration
- Decision Making and Adaptability
- Coverage Determination
- Settlement Negotiation
- Claims Investigation
- Litigation Management
Timeline
Bodily Injury Claims Specialist
State Farm
11.2022 - Current
Claims Specialist
GEICO
03.2022 - 11.2022
Banker
Bank of America
10.2014 - 03.2022
Bachelor of Arts - Business Management
Alpha University College