Raquel Marshall
New York,NY
Summary
Seasoned Claims Examiner with over 10 years of experience in managing and resolving complex claims, including Workers' Compensation, Litigated Bodily Injury, Homeowners Insurance, and General Liability. Demonstrated expertise in conducting thorough investigations, determining liability, setting reserves, and managing legal aspects of claims. Skilled in maintaining compliance with company policies and regulatory standards, with a strong focus on delivering superior results and exceptional customer service.
Overview
21
21
years of professional experience
Work History
Workers' Compensation Representative
CorVel Corporation
New York
08.2023 - Current
- Handle a caseload of complex workers' compensation claims, ensuring timely and accurate processing
- Conduct thorough investigations to determine claim validity and compensability
- Set and maintain adequate reserves based on case facts and company guidelines
- Manage and document all aspects of the claims process in the company's electronic claims management system
- Maintain regular communication with injured employees, employers, medical providers, and legal professionals
- Provide updates and information regarding claim status, benefits, and return-to-work programs
- Coordinate medical treatment and case management to facilitate the injured employee's recovery and return to work
- Ensure compliance with state workers' compensation regulations and company policies
- Manage litigated claims by collaborating with defense counsel, attending depositions, and participating in mediations and hearings
- Develop and implement return-to-work plans in collaboration with employers and medical providers
- Monitor progress and adjust plans as needed to ensure successful and timely return to work for injured employees
- Promote early return-to-work initiatives to minimize the impact of injury on both employees and employers
- Provide exceptional customer service to injured employees, employers, and other stakeholders
- Educate employers and employees about workers' compensation benefits, rights, and responsibilities.
Litigated Bodily Injury Representative
Allstate Insurance
08.2010 - 08.2023
- Effectively managed and resolved a high volume of litigated bodily injury claims, ensuring thorough investigation, evaluation, and negotiation to achieve optimal settlements
- Skillfully handled unrepresented bodily injury claims, providing clear communication and guidance to claimants while protecting the interests of Allstate Insurance
- Managed and resolved complex homeowners and general liability claims, conducting comprehensive investigations, and coordinating with various stakeholders
- Successfully led and mentored a team of 11 claims professionals, fostering a collaborative and productive work environment, and ensuring adherence to company policies and procedures
- Expertly prepared and presented cases for arbitration, achieving favorable decisions through meticulous preparation and persuasive argumentation
- Consistently delivered exceptional customer service by maintaining clear, compassionate, and professional communication with claimants and stakeholders
- Ensured compliance with all regulatory requirements and maintained accurate and detailed documentation for all claims.
Senior Claims Representative
Esurance
04.2007 - 08.2010
- Handled complex bodily injury claims from inception through resolution, including litigated and unrepresented cases
- Conducted detailed investigations and evaluations of claims, negotiating settlements and providing clear communication to all parties involved
- Managed total loss claims, ensuring accurate assessments and timely resolutions
- Assisted in developing and implementing claims handling procedures and best practices
- Provided training and support to junior claims representatives, enhancing team performance and efficiency
- Actively participated in arbitration and mediation processes, contributing to favorable claim resolutions.
Claims Adjuster
Geico
01.2004 - 04.2007
- Managed a diverse portfolio of bodily injury claims, including evaluation, negotiation, and settlement of claims
- Conducted thorough investigations, including gathering evidence, interviewing witnesses, and assessing damages
- Maintained accurate documentation and ensured compliance with company policies and legal regulations
- Delivered exceptional customer service and resolved claim disputes through effective communication and problem-solving
- Completed a comprehensive 4-month Management Trainee Program, gaining extensive knowledge of various insurance types and training to become a coach for other claims professionals.
Education
Associate Degree - Business Administration
Skills
- Claims Management
- Liability Determination
- Investigation and Analysis
- Legal and Medical Documentation Review
- Negotiation and Settlement Strategies
- Compliance with State and Federal Regulations
- Litigation Management
- Return-to-Work Programs
- Training and Development
- Customer Service Excellence
- Strong Analytical and Problem-Solving Skills
- Excellent Verbal and Written Communication
- Proficiency in Microsoft Office and Claims Management Software
Timeline
Workers' Compensation Representative
CorVel Corporation
08.2023 - Current
Litigated Bodily Injury Representative
Allstate Insurance
08.2010 - 08.2023
Senior Claims Representative
Esurance
04.2007 - 08.2010
Claims Adjuster
Geico
01.2004 - 04.2007