SCHELLAINA M. AUGUSTINE
Zachary,USA
Summary
Dynamic casualty adjuster with a proven track record at Shelter Insurance, excelling in liability assessment and negotiation. Recognized for achieving a 95% success rate in settlements, I leverage strong analytical thinking and effective communication to drive results. Adept at cross-functional collaboration, I consistently enhance claims processes and customer satisfaction. Skilled in navigating complex insurance claims and providing thorough investigations to ensure fair settlements. Have experience coordinating with legal teams, policyholders, and insurance companies to manage claims efficiently. Known for strong analytical skills, ability to interpret policy details accurately, and effective communication that results in resolved disputes. Made significant impacts by streamlining claims processing procedures, enhancing customer satisfaction through timely resolutions.
Overview
18
18
years of professional experience
Work History
Casualty Adjuster - Bodily Injury
Shelter Insurance
03.2020 - 10.2024
- Conducted interviews with insureds, claimants, witnesses, and key parties.
- Set and adjust reserves as needed throughout the claims process.
- Reviewed liens associated with Medicare, Medicaid, and other interested parties.
- Implemented denial notification procedure through official disclaimers.
- Highlighted claims plans, and settlement recommendations to management and legal advisors in cases of excess liability.
- Created action plans for SIU to aid in external investigations and virtual sweeps.
- Handled third-party liability negotiations for subrogation optimization.
- Facilitated resolution of liability disputes to avoid executing the arbitration process.
- Negotiated settlements with unrepresented third parties, with a 95% success rate on the first offer, and a 90% success rate on the first counter-offer that are represented.
- Reviewed citations and provided detailed file summary notes for legal defense to assist in advancing defense strategies with both internal and external lawyers, on behalf of the insured and the insurance company.
- Addressed excess and umbrella policies in cases where these situations are present, and further settlement components are warranted.
- Attended mediations or arbitration hearings as a representative of the insurer.
- Advised clients on their rights under relevant state regulations.
- Reviewed policies to determine appropriate levels of coverage and assist with approval or denial decisions.
- Communicated with reinsurance brokers to obtain claim information for processing.
- Analyzed medical reports to determine compensability for bodily injury claims.
- Reviewed police reports to assess liability for personal injury cases.
Liability Claims Adjuster
Progressive Insurance Company
10.2012 - 02.2017
- Managed claim files with complete responsibility for coverage and liability investigations.
- Applied endorsements, exclusions, and additional policy documents in interpreting coverage for reported claims.
- Issued reservation of rights letters to address potential coverage lapses.
- Conducted interviews to obtain recorded statements from all involved parties.
- Analyzed police reports, virtual scenes, and multimedia to evaluate liability.
- Collaborated with cross-functional teams, such as the Special Investigations Unit (SIU), in cases of potential fraud identified in a loss.
- Created and assigned inspection tasks for field team.
- Collaborated with subrogation and arbitration teams to enhance recovery strategies.
- Developed structured plans regularly to optimize diary management and meet monthly inventory objectives.
- Managed caseload effectively, prioritizing urgent or high-value claims for prompt attention.
- Resolved claim disputes through mediation and negotiation, minimizing the need for litigation.
- Reduced loss ratios through fair and prompt processing of claims.
Manager
Walmart
10.2010 - 10.2012
- Developed cross-merchandising strategies for optimal profitability of over $8 million in company assets.
- Secured optimal placement of products to elevate store footfall.
- Delivered a measurable decline in electronic theft rates by enforcing and optimizing standard operating processes at the store level.
- Directed routine activities for a team of roughly 300 personnel, including hourly managers and subordinates.
- Facilitated knowledge transfer to fresh employees through leadership and mentoring.
- Analyzed business performance data and forecasted business results for upper management.
- Enforced customer service standards and resolved customer problems to uphold quality service.
- Negotiated contracts and agreements with vendors and suppliers to reduce costs.
- Provided leadership during times of organizational change or crisis situations.
- Resolved customer complaints and issues promptly, maintaining a positive brand image.
- Completed thorough opening, closing, and shift change functions to maintain operational standards each day.
- Evaluated individual and team business performance and identified opportunities for improvement.
- Organized team activities to build camaraderie and foster pleasant workplace culture.
- Oversaw daily operations, maintaining efficiency and quality standards.
- Held regular one-on-one meetings with employees to review performance and priorities and provide feedback.
- Recruited and trained new employees to meet job requirements.
- Managed inventory levels to meet demand without overstocking, reducing waste.
- Assigned work and monitored performance of project personnel.
- Coordinated cross-departmental projects to ensure timely and successful completion.
Management Assistant
Enterprise Rent A Car
07.2006 - 07.2010
- Concentrated on advancing business growth.
- Identified potential business partners and secured meetings with key decision-makers to drive collaboration.
- Explored prospective partnerships by targeting businesses with unique rental needs.
- Assessed client requirements regarding personal accident insurance and supplemental liability options.
- Oversaw everyday functions of branch affiliates.
- Prepared comprehensive reports and presentations for internal and external meetings.
- Assisted in developing marketing campaigns aimed at increasing brand recognition.
- Maintained positive working relationship with fellow staff and management.
- Processed invoices and verified accuracy of financial documents prior to submission.
Education
Bachelors - Marketing - Sales Concentration
Southern University A & M College
Baton Rouge, LA05-2006
Skills
- Data Analysis
- Data Interpretation
- Strategic Planning
- Business Writing
- Verbal Communication
- Investigation Planning
- Medical Terminology Interpretation
- Time Management
- Leadership
- Problem Solver
- Negotiations
- Critical Thinking
- Organization
- Diary Management
- Technical Knowledge
- Claims Support Programs
- ISO
- TLO
- CMS
- MSP
- Navigator
- ALS
- Claims 20
- ClaimsPro
- Microsoft Word
- Excel
- PowerPoint
- Outlook
- OneNote
- Teams
- Zoom
- Claims management
- Liability assessment
- Medical document evaluation
- Settlement negotiation
- Fraud investigation
- Reserves adjustment
- Policy interpretation
- Customer service
- Cross-functional collaboration
- Conflict resolution
- Attention to detail
- Analytical thinking
- Report writing
- Team leadership
- Effective communication
Licenses Memberships Accomplishments
- Licensed Property & Casualty Adjuster - Louisiana, Arkansas, Kentucky, and Oklahoma
- Progressive Insurance - President's Customer Service Award
- Progressive Insurance - Monthly leader for controlled inventory
- Sales Award - Enterprise Rent A Car, Multiple Top Sales Award
- PI SIGMA EPSILON (Epsilon Rho), Chartering President - Southern University
Timeline
Casualty Adjuster - Bodily Injury
Shelter Insurance
03.2020 - 10.2024
Liability Claims Adjuster
Progressive Insurance Company
10.2012 - 02.2017
Manager
Walmart
10.2010 - 10.2012
Management Assistant
Enterprise Rent A Car
07.2006 - 07.2010
Bachelors - Marketing - Sales Concentration
Southern University A & M College
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