NICOLE DAVIS
Novato,CA
Summary
Claims Expert with extensive experience managing high-severity litigated and coverage-disputed claims. Demonstrated expertise in expense control and lifecycle oversight, improving resolution strategies and service levels. Utilizes strong communication, negotiation, and AI-enabled tools to enhance innovation and ensure compliance within the claims process.
Overview
26
26
years of professional experience
Work History
Senior Claims Examiner, Workers' Compensation
Republic Indemnity
San Francisco, USA
01.2015 - Current
- Managed high-severity, complex claim portfolios for large commercial accounts, ensuring effective resolution and client satisfaction.
- Led litigated and pre-litigated claims, directing investigative services and defense counsel while maintaining disciplined expense control to optimize outcomes.
- Oversaw full lifecycle of claims, including investigation, medical billing review, valuation methodology, structured resolution planning, mediation, litigation, subrogation, and contribution recovery, ensuring comprehensive claim resolution.
- Trained peers and provided technical expertise on valuation, litigation strategy, and management of challenging files, promoting knowledge sharing and support within the team.
- Contributed insights as an early adopter of AI-enabled claims programs, enhancing their effectiveness in resolving complex claims.
- Monitored adherence to Department of Insurance regulations to maintain operational integrity.
Paralegal
Emison Hullverson, LLP
San Francisco, USA
01.2013 - 01.2015
- Executed litigation tasks, including docketing, filing documents, and reviewing medical records for case preparation.
Auto Claims Representative
State Farm Insurance
Emeryville, USA
01.2000 - 01.2013
- Managed bodily injury, UM/UIM, coverage-disputed, and litigated claims, ensuring timely resolutions and adherence to legal standards.
- Negotiated settlements with in-house and external counsel, achieving equitable outcomes for all parties.
- Investigated complex losses, collaborating with medical and technical experts to ensure accurate claims assessment.
- Worked with Corporate Claims Litigation and Coverage Attorney Experts to change the policy language of PLUP policy to limit exposure for permissive drivers.
Education
Bachelor of Arts - Art History
Mills College
Oakland, CASkills
- Claims Triage
- Exposure Evaluation
- Oversight of Claim Handling Partners
- SLA Accountability
- Professional Customer Interaction
- Stakeholder Interaction
- Strategic Documentation
- Negotiation
- Process Improvement
- Claims Innovation
- High Emotional Intelligence
- Composure
- Complex claims management
- Risk assessment
- Litigation strategy
- Valuation methodology
Personal Information
Title: Claims Specialist - Workers' Compensation & Liability
Core Claims Advocacy Competencies
- Claims Triage & Exposure Evaluation: Investigates and evaluates complex, litigated, and high-exposure claims, with experience determining exposure and response strategy.
- Oversight of Claim Handling Partners & SLA Accountability: Leads defense counsel and investigative services with disciplined oversight and compliance focus.
- Professional Customer & Stakeholder Interaction: Provides clear communication, sets expectations, and supports claimants through stressful events.
- Strategic Documentation & Negotiation: Builds defensible claim files, identifies key issues, and negotiates settlements on complex and litigated matters.
- Process Improvement & Claims Innovation: Participates in enterprise initiatives and evaluation of AI-enabled claims tools relevant to complex claim handling.
- High Emotional Intelligence & Composure: Maintains calm, fact-based decision-making in contentious or high-pressure litigated environments.
Professional Summary
Highly experienced complex claims expert with 20+ years managing high-severity, litigated, and coverage-disputed claims across workers' compensation, liability, and auto portfolios. Proven ability to triage, investigate, evaluate, and negotiate complex losses—directly aligning with the requirement to review and triage claims, determine exposure, and protect company interests. Consistently recognized for superior judgment, reserve integrity, and decisive resolution strategy, supporting strong oversight of claim handling partners, adherence to expectations, and maintenance of service levels. Brings deep skills in clear communication, negotiation, strategic documentation, and empathy, combined with early adoption of AI-enabled claims tools and participation in enterprise initiatives focused on complex claims and innovation.
Timeline
Senior Claims Examiner, Workers' Compensation
Republic Indemnity
01.2015 - Current
Paralegal
Emison Hullverson, LLP
01.2013 - 01.2015
Auto Claims Representative
State Farm Insurance
01.2000 - 01.2013
Bachelor of Arts - Art History
Mills College