Nygheema Felton
Virginia Beach,Virginia
Summary
Seasoned collaborator experienced in meeting needs, improving processes, and exceeding requirements in team environments. Diligent worker with strong communication and task prioritization skills.
Overview
6
6
years of professional experience
Work History
Claims Care Center Manager
American Family Insurance Claims Services, Inc.
Virginia Beach, United States
02.2022 - Current
- Leads team of claim care center representatives in delivering exceptional claims experiences for policyholders in legal/regulatory compliant and cost-effective manner.
- Actively manage and improve claims handling process and care center operations.
- Manages direct reports, systems, and projects to achieve operational goals.
- Monitor team performance, enforcing compliance with corporate claims processes and procedures.
- Conducts detailed claims file reviews of representatives to identify specific administrative, contractual, case documentation, compliance, and remedial training needs.
- Document and communicate timely claims information while supporting accurate outcomes.
- Directs claims representatives in evaluating factual information, applying understanding of policy contract provisions, identifying applicable coverages and liability, and determining fair settlement values. Establishes and maintains appropriate reserves within settlement authority, requesting additional authority as needed.
- Identifies professional development needs and cross-functional training opportunities for each representative and schedules training/development sessions.
- Conducts unit meetings to discuss performance results, plans for improvement, upcoming training events, and other company-related events/issues.
- Checks payroll, vendor payments, commissions, and other accounting disbursements for accuracy and compliance.
Senior Bodily Injury Adjuster
National General Insurance Company
Virginia Beach, Virginia
08.2021 - 02.2022
- Reviewed claims for accuracy and completion with regard to the investigation into facts of loss, coverage, and liability, settlement value, settlement options, and plan of action recommended by reassigning party; determine if the additional investigation, medical documentation, or work is needed; determine settlement value and settlement options and negotiate injury claims of serious and complex nature within authority granted.
- Established liability investigation plan with telephone claims representative on initial losses received; when needed, assist in investigation by gathering facts and evidence with all witnesses and interested parties, take recorded statements, analyze the extent of property damage and reviewing loss reserves, adjusting and/or opens hidden exposures.
- Determined if potential subrogation or fraud issues exist and refer to appropriate claim unit for handling, with recommendation on the plan of action, or may independently determine to handle issues to conclusion.
- Gathered, analyzed, and evaluated for settlement purposes all supportive medical documentation which may include obtaining medical authorizations, and medical and lost wage records.
- Assisted in training, developing, and mentoring Claim Representatives as needed
- Acted as subject matter expert in regard to complex and/or legal claim handling issues
- Assisted with file audits, research projects, and other assignments as needed.
- Assisted management with organizing, facilitating and participating in file roundtables as needed.
- Assumed a leadership role in absence of management.
Auto Claims Adjuster
USAA
Chesapeake, VA
09.2015 - 02.2021
- Analyzed first and third-party claims to determine extent of company's liability.
- Established and maintained high level of positive working relationships with internal and external customers, ensuring satisfaction with company services.
- Determined insurance coverage levels and restrictions by thoroughly examining claims forms and associated records.
- Paid and processed claims within designated authority level.
- Improved profit margins by streamlining operations and workflow and negotiating competitive vendor contracts.
- Negotiated settlements and agreements between parties by providing mutual support and driving resolutions.
- Applied knowledge of P&C insurance industry products, services, and processes to include P&C insurance policy contracts & coverages, tort law, contract law, state statutes, evidence, and damages.
- Established timely reserves and performing ongoing reviews throughout claims-cycle by estimating and validating value of claims.
- Supported Underwriting teams and key stakeholders in connection with claim trends, marketing, and business development.
- Recognized as internal resource providing technical guidance, assistance, and training to new associates.
- Determined value of claim considering depreciation and actual cash value, negotiates and commits to settlement, and moves claim to closure.
- Resolved complaints, and participates in arbitration and grievance procedures.
- Created and documented claims file to comply with company guidelines and state regulations.
Education
MBA - Business Management
Strayer University
Washington, DC06.2024
BBA - Business Administration
Berkeley College
Woodland Park, NJ05.2012
Skills
- Critical Thinking
- Time Management
- Analytical
- Problem-solving
- Negotiation
- Customer Service
- Decision Making
- Investigation
- Microsoft Office
- Performance Monitoring and Evaluation
- Policy Interpretation
- Business Leadership
Affiliations
- Society For Collegiate Leadership & Achievement
Timeline
Claims Care Center Manager
American Family Insurance Claims Services, Inc.
02.2022 - Current
Senior Bodily Injury Adjuster
National General Insurance Company
08.2021 - 02.2022
Auto Claims Adjuster
USAA
09.2015 - 02.2021
MBA - Business Management
Strayer University
BBA - Business Administration
Berkeley College
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