Roderick Middleton
Warner Robins,GA
Summary
Results-driven Senior Claims Adjuster and SIU Investigator with expertise in complex claim investigations, fraud detection, and regulatory compliance. Manages high-exposure claims through thorough evidence analysis and strategic resolutions. Collaborates with law enforcement and legal teams to mitigate risks and ensure accurate claim outcomes. Committed to maintaining integrity in insurance operations through effective case management and critical thinking.
Overview
1
1
Certification
15
15
years of professional experience
Work History
SIU Investigator
GEICO
Macon, GA
09.2024 - Current
- Conducted complex Special Investigations Unit (SIU) investigations involving suspected insurance fraud, staged accidents, questionable injury claims, material misrepresentation, and suspicious claim activity.
- Managed a caseload of complex automobile bodily injury (BI) claims by evaluating liability, coverage, damages, injury causation, and claim exposure.
- Performed comprehensive claim investigations through analysis of medical records, police reports, prior claim history, recorded statements, examinations under oath (EUOs), accident documentation, and supporting evidence.
- Identified fraud indicators and financial riskexposure through investigative analysis, claimant interviews, provider reviews, and documentation discrepancies.
- Collaborated with claims leadership, defense attorneys, law enforcement, medicalprofessionals, and internal partners to developinvestigative strategies and achieve fair claim resolutions.
- Prepared detailed SIU investigative reports documenting findings, evidence analysis, recommendations, and claim handling strategies for management review.
- Evaluated high-exposure bodily injury claims to mitigate financial loss, reduce claim severity, and protect company assets.
- Utilized critical thinking, analytical skills, andinvestigative techniques to identify fraudulentactivity and improve claim outcomes.
- Provided guidance to claims professionals regarding SIU referral criteria, fraud indicators, and best practices for complex claim handling.
Coverage Damage Specialist
GEICO
Macon, GA
08.2021 - 09.2024
- SME handling claims referred to Special Investigations Unit (SIU) for potential fraud while identifying complicated coverages or liabilities
- Management of Property damage excess claims calculation, allocation and negotiation of Pro-Rata shares per interested party.
- Ensure all state specific guidelines, procedural and regulatory requirements are met and coverages are handled according to the policy contract
- Corresponded with 1st party attorneys to facilitate medical benefits and coverage investigations
- Investigated complex coverage issues, including policy applicability, exclusions, endorsements, and potential misrepresentation concerns to determine claim eligibility.
- Managed evaluation and estimation of total costs for loss of revenue claims, ensuring accurate assessments
- Identified potential fraud indicators and referred suspicious claims for additional review by Special Investigations Unit (SIU).
- Documented claim activity, investigative findings, reserve recommendations, and payment decisionsaccurately within claims management systems.
CSR Coach
GEICO
Macon, GA
06.2020 - 08.2021
- Provided real-time coaching and feedback to improve accuracy, efficiency, compliance, and overall customer experience.
- Supported onboarding and development of new claims representatives through structured training, side-by-side coaching, and performance evaluations.
- Monitored claim interactions, call quality, documentation accuracy, and adherence to company policies and regulatory requirements.
- Reviewed performance metrics and identified coaching opportunities to improve customer satisfaction, first-call resolution, and claim handling effectiveness.
- Assisted team members with complex customer inquiries, claim escalations, coverage questions, and issue resolution strategies.
- Coached and mentored Claims Customer Service representatives on claim handling procedures, customer communication strategies, system processes, and best practices to improve servicequality and operational performance.
TCR1 Adjuster - Southeast Region
GEICO
Macon, GA
02.2017 - 05.2020
- Managed First Notice of Loss (FNOL) intake and claim setup activities, gathering loss details, verifying policy information, documenting claim facts, and initiating investigations to support timely claim resolution.
- Handled complex contract liability claim investigations and coverage disputes by analyzing policy provisions, claim documentation, liability factors, and applicable state guidelines.
- Conducted thorough investigations to determine contract coverage applicability, liability exposure, and appropriate claim outcomes while ensuring compliance with regulatory requirements and company standards.
- Collaborated with first-party legal counsel, attorneys, and internal stakeholders to coordinate claim strategies, address disputes, and facilitate resolution of client benefit matters.
- Researched state regulations, policy language, and contractual requirements to support accurate coverage determinations and defensible claim decisions.
- Prepared and distributed comprehensive claim documentation, investigative summaries, and final determinations to communicate coverage decisions, liability findings, and claim resolutions clearly.
COMPANY DRIVER
Coleman American & Allied
Warner Robins, GA
03.2014 - 02.2017
- Regional driver servicing the Southeastern portion of the US
- Inventorying customers' household goods previous of wrapping furniture
- Inventorying customers' household goods previous of wrapping furniture
- Disassembled and reassembled items for safe transport.
- Logistical planning, organizing, and coordination of loading crew, packers and wrappers
- Managed allocated funds for each job to ensure budget adherence
- Handled paperwork for each job to maintain accurate records
SENIOR GRAPHIC DESIGNER
Intergraph Government Solutions
Warner Robins, GA
11.2011 - 03.2014
- DoD contractor support for a collaborative IPT including 9 United States Air Force (USAF) Technical Order (TO) Technical Editors to create Standard Visual Work Cards (SVWC) and Pre-Induction Inspection (PII) cards for the High Velocity Maintenance (HVM) program producing/editing 846 graphics and creating 87 PII cards in 30 days
- Created high-quality 2D technical illustrations utilizing photo-trace or repurpose of existing technical and legacy data
- Produced high-quality 2D technical illustrations by photo-tracing and repurposing existing technical and legacy data to enhance documentation clarity.
- Converted raw data inputs into highly digitized Interactive Electronic Technical Manual System (IETMs)
- Acted as Quality Assurance (QA) inspector for card call outs and illustrations to maintain consistency with USAF requirements and detail relevance
- Researched and optimized historical information and graphic illustrations to support daily and special projects, ensuring accuracy and relevance.
Education
Bachelor of Science - Graphic Design
The Art Institute (AI) of Atlanta
Atlanta, GASkills
- Coverage Evaluation
- Insurance Compliance
- Risk Assessment
- Coverage Analysis
- Claims Investigations
- Complex Claim Management
- Settlement Negotiation
- Liability Investigation
- Fraud Prevention
- EUO (Examination Under Oath)
- High Exposure Claims
- Special Investigation Unit (SIU)
- Detail Oriented
- Medical Records Review
Certification
- 10/2013, GA Commercial Driver License (CDL), 053069523
- Property and Casualty Insurance Licenses
Timeline
SIU Investigator
GEICO
09.2024 - Current
Coverage Damage Specialist
GEICO
08.2021 - 09.2024
CSR Coach
GEICO
06.2020 - 08.2021
TCR1 Adjuster - Southeast Region
GEICO
02.2017 - 05.2020
COMPANY DRIVER
Coleman American & Allied
03.2014 - 02.2017
SENIOR GRAPHIC DESIGNER
Intergraph Government Solutions
11.2011 - 03.2014
Bachelor of Science - Graphic Design
The Art Institute (AI) of Atlanta