Sandra Middleton
Dallas,Texas
Summary
Organized and detail-oriented professional Insurance Claims Adjuster dedicated to improving efficiency, productivity, and profitability through continuous process improvement. Analytical thinker skilled at developing innovative solutions to complex problems. Insurance Adjuster skilled in investigating and analyzing liability concerning personal, casualty or property loss. Proven history of leveraging excellent negotiation skills to facilitate settlements. Excellent communication skills demonstrated through 2 years of experience interviewing specialists, witnesses and claimants to compile information.
Overview
8
8
years of professional experience
Work History
Adjuster
Independent, Pilot Catastrophe Services
09.2021 - 10.2023
- Worked with customers to arrange Vehicle inspections
- Became certified and licensed to handle claims in several different states
- Answered customer questions regarding deductibles
- Confirmed facts of loss
- Responded to customer inquiries, made appropriate decisions and closed files
- Evaluated insurance policies and analyzed damages to determine coverage
- Prepared summaries of damage, payments, and policy coverage
- Coordinated with local body shops to assign repair jobs and obtained rental vehicles for Insured
- De-escalated and resolved customer complaints with punctual, polite, and professional service
- Affirmed or denied coverage of claims based on facts and policy terms and conditions
- Developing information necessary to make advance, partial and final payments when appropriate
- Evaluate documents from Auto injury claim and forwarding them to assigned adjuster
- Subrogation
- Total Loss according to particular State guidelines
- Request and Evaluate Bodily Injury documents
- Document review and submission for Bodily Injury
- Review vehicle damages to determine if vehicle is repairable or not.
- Directed claims negotiations within allowable limit of loss
- Improved claim processing efficiency by conducting thorough investigations and promptly addressing discrepancies
- Enhanced client satisfaction by providing timely updates and effectively resolving claim disputes
- Reduced backlogs of pending claims using effective time-management strategies such as prioritizing tasks based on urgency or complexity levels
- Assisted clients in understanding their insurance coverage by explaining complex terms and conditions clearly and concisely
- Analyzed information gathered by investigations to report findings and recommendations
- Resolved complex, severe exposure claims using high service oriented file handling
Property Claims Adjuster
IAS Claims Services
07.2021 - 09.2021
- Conducted thorough investigations as outlined in claim
- Negotiate and resolve assigned claims in accordance with client guidelines
- Take recorded statements as needed
- Addressed diaries, emails and voicemails
- Paid Claims and updated payment information.
Property Desk Adjuster
Alacrity Claim Solutions
06.2021 - 07.2021
- Reviewed the Insurance policy to determine coverage and eligibility
- Reviewed onsite pictures of property damages
- Interview Claimants and collect public information about the incident that caused the loss of property
- Collected payment information and submitted claim for payment.
Surgery Charge Correction Clerk
Anesthesia Partners
08.2019 - 09.2020
- Captured and entered Professional charges
- Corrected Anesthesia Procedure times
- Submitted corrected charges to the Insurance Company
- Verified Insurance eligibility status
- Calculated actual times that Anesthesia was rendered.
Insurance Verification Specialists
Texas Health Resources
03.2016 - 08.2019
- Verified Insurance Eligibility
- Making sure patients have proper insurance coverage for services provided by clinic
- Conducted phone interviews
- Contacted Insurance carriers to verify eligibility and to get Pre-Cert authorizations
- Scheduling appointments with specific clinic according to patients' medical needs
- Coordinating with assigned clinics to assure adequate care needs.
Education
Associate of Arts - Fashion and Merchandising
Miss Wades Fashion And Merchandising College
Dallas, TX03.1987
High School Diploma - Basics
Wilmer Hutchins High School
Hutchins, TX05.1982
Skills
- Problem Solving
- Negotiation of Losses
- Investigates, evaluates and finalizes claims resulting from losses
- Maintained updated knowledge of claims, current guidelines, and court decisions impacting claim's function
- Checked official documentation such as police reports and medical treatment records to determine extent of company's liability
- Also hold Adjuster Licenses from 16 States as follows
- Texas
- Oklahoma
- Kentucky
- Michigan
- Mississippi
- Georgia
- West Virginia
- Alabama
- Louisiana
- Florida
- Washington
- Arkansas
- New Mexico
- Montana
- Indiana
- South Carolina
Timeline
Adjuster
Independent, Pilot Catastrophe Services
09.2021 - 10.2023
Property Claims Adjuster
IAS Claims Services
07.2021 - 09.2021
Property Desk Adjuster
Alacrity Claim Solutions
06.2021 - 07.2021
Surgery Charge Correction Clerk
Anesthesia Partners
08.2019 - 09.2020
Insurance Verification Specialists
Texas Health Resources
03.2016 - 08.2019
Associate of Arts - Fashion and Merchandising
Miss Wades Fashion And Merchandising College
High School Diploma - Basics
Wilmer Hutchins High School
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