Niona Grier
Charlotte,NC
Summary
Skilled claims professional with strong expertise in assessing, processing, and resolving insurance claims efficiently. Adept at working in collaborative environments, ensuring seamless teamwork and adaptable to changing needs. Demonstrates keen analytical skills, attention to detail, and excellent communication abilities, driving successful outcomes and client satisfaction.
Overview
17
17
years of professional experience
Work History
Specialized Sr Claim Rep, Workers Compensation
Travelers Insurance
06.2024 - Current
- Developed strong relationships with clients, fostering trust and loyalty to the company.
- Provided exceptional service to policyholders during catastrophes, ensuring their needs were met quickly and effectively.
- Prioritized workload effectively under pressure, consistently meeting deadlines without sacrificing quality or accuracy in claim processing tasks.
- Investigated complex claims thoroughly, resulting in fair settlements for both parties involved.
- Assisted colleagues with challenging cases, sharing expertise to reach successful outcomes for all parties involved.
- Enhanced customer satisfaction by providing timely and accurate claim resolutions.
- Negotiated settlement agreements that were mutually beneficial for both clients and the company while maintaining professional relationships.
- Continuously improved personal knowledge of industry trends and developments through ongoing training initiatives, enhancing job performance capabilities.
- Offered support to new team members, acting as a mentor by sharing insights gained from years of experience in the field of claims handling procedures.
Return to Work Case Manager
Travelers Insurance Company
12.2013 - 06.2024
- Perform telephonic case management of Workers Compensation with lost time to conclusion and negotiate settlements where appropriate to resolve claims.
- Contact injured workers, insureds and medical providers in a timely manner to gather relevant info to assist in the investigation and evaluation of the claim.
- Manage files with an emphasis on file quality while maximizing internal resources, and achieving a positive end result by returning injured party to work.
- Build strong partnership with our internal nurse resources (Medical Case Manager) in order to integrate the delivery of medical services to the injured worker.
- Develop strategies to manage losses involving issues of statutory benefit entitlement, medical diagnoses, Medicare Set Aside to achieve resolution through the best possible outcome.
- Effectively manage litigation to drive files to an optimal outcome, including resolution of benefits.
Auto Damage Adjuster
Travelers Insurance Company
05.2013 - 12.2013
- Handle all types of vehicles including automobiles, and a variety of heavy and mobile equipment (i.e. Cranes, tractor trailers, construction, agricultural equipment) at every severity level including other property damage i.e.: guard rails, mail boxes and any property within the vehicle.
- Handle vehicle claims with varying degrees of complexity and severity (I.e.: coverage issues, multi-car, fatalities, liability determination, etc.).
- Review, analyze and make coverage determination and apply policy conditions, provisions, exclusions and endorsements, pertinent to a variety of vehicle damage claims.
- Recognize and apply how jurisdictional issues impact claim (i.e.: negligence laws, financial responsibility/limits, immunity, etc.).
- Contact all appropriate parties to obtain all relevant facts necessary to determine coverage, medical necessity, treatment plan, causation/damages, and exposure with respect to the various vehicle coverage provided.
- Investigate facts to establish negligence, determine liability, other sources of recovery and negotiate resolutions as appropriate.
- Manage fire, theft and other claims that require specialized investigation and utilization of internal and external experts in accordance with local laws.
Medical Adjuster
Travelers Insurance Company
08.2010 - 05.2013
- Investigate medical claims.
- Review medical records and bills.
- Disburse, reimburse, or recoup medical funds paid out to providers.
- Knowledge of NC and SC state Insurance Laws including HIPPA regulations.
- Recognize and forward appropriate files to SIU. Recognize additional coverage issues, as well as jurisdictional issues.
- Participate in various committees'/focus groups/special projects as needed.
- Trained Operations staff member to assist the First Party Medical unit.
Total Loss Claim Representative
Travelers Insurance Company
06.2008 - 08.2010
- Negotiate and settle total loss claims.
- Provide excellent customer service with internal and external customers.
- Multitask new claims, inventory, and rental.
- Evaluate and identify with total loss automobiles, estimates, and reports.
- Perform additional leadership skills: Team Leader, Felix peer interviewing, Social committee.
Education
Bachelor of Science - Business Administration, Management, Human Resources
University of North Carolina At Charlotte
Charlotte, NC12.2007
Associates Degree - Arts
Central Piedmont Community College
Charlotte, NC12-2005
Skills
- Accountability
- Organizational Skills
- Conflict Resolution
- Relationship Management
- Collaboration
- Time Management
- Claims investigation
- Team collaboration
- Decision-making
- File management
- Coverage determination
- Settlement negotiation
Areas Of Effectiveness
Capable of demonstrating a high level of service delivery while maintaining clear communication with customers both internal and external., Successful in skillfully negotiating and meeting commitments to customers all while building rapport and trust., Accomplished in proactively managing workload through prioritizing, planning, and timely follow-up., Takes ownership and responsibility for actions, outcomes and performance results., Qualified in using the win-win approach to resolve conflict., Successful in leveraging differences and working closely with other business units as necessary while responding to matters with a sense of urgency.
Timeline
Specialized Sr Claim Rep, Workers Compensation
Travelers Insurance
06.2024 - Current
Return to Work Case Manager
Travelers Insurance Company
12.2013 - 06.2024
Auto Damage Adjuster
Travelers Insurance Company
05.2013 - 12.2013
Medical Adjuster
Travelers Insurance Company
08.2010 - 05.2013
Total Loss Claim Representative
Travelers Insurance Company
06.2008 - 08.2010
Bachelor of Science - Business Administration, Management, Human Resources
University of North Carolina At Charlotte
Associates Degree - Arts
Central Piedmont Community College
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