Shannel Hodgson
Mississauga
Summary
Highly experienced insurance professional with a strong background in accident benefits claims adjusting. Skilled in collaborating with cross-functional teams and external vendors to optimize case management and ensure comprehensive claim assessments. Adept at leveraging analytical and technical skills to manage risks, conduct thorough investigations, and provide exceptional customer service. Proven ability to streamline processes, enhance operational efficiency, and deliver accurate, data-driven insights for informed decision-making. Committed to continuous improvement and maintaining up-to-date knowledge of industry regulations and best practices.
Overview
8
8
years of professional experience
1
1
Certification
Work History
Accident Benefits Claims Adjuster
Peel Mutual Insurance
Brampton, Ontario
09.2018 - 03.2020
- Investigated insurance claims filed by policyholders and injured parties, ensuring thorough and accurate assessments.
- Researched policy wordings to confirm insurance coverage and identify all potential insurer exposures upon claim initiation.
- Examined photographs, video surveillance material, audio clips, witness statements, driver abstracts, and other relevant documentation to substantiate claims.
- Documented all findings in concise claims reports, ensuring clarity and completeness.
- Negotiated and settled claims with claimants and Plaintiff's Counsel, achieving fair and equitable resolutions.
- Analyzed claims to determine validity and compliance with policy guidelines.
- Assisted with onboarding Guidewire Claims handling system from Beta implementation to full-system onboard usage.
Intermediate Accident Benefits Claims Adjuster
Northbridge Insurance
Toronto, Ontario
03.2020 - 08.2023
- Directed internal and external vendors, legal counsel, rehabilitation firms, and investigative firms to ensure effective collaboration and case management.
- Participated in settlement initiatives, including private and mandatory FSCO mediation, to negotiate fair and equitable resolutions.
- Maintained comprehensive and up-to-date claim files, including accident benefits packages, clinical notes, records, and legal documents.
- Calculated ultimate probable exposures and set reserves, accordingly, managing financial risks and ensuring accurate accounting.
- Analyzed and interpreted insurance policy wording to determine coverage and assess entitlements, handling moderately to severely injured claimants with precision.
Senior Accident Benefits Claims Adjuster
Sedgwick CMS Canada
Mississauga, Ontario
08.2023 - 03.2025
- Proactively managing a pending of over one hundred and fifty Accident Benefits Claims with non-catastrophic to catastrophic level injury classifications.
- Investigated complex claims by gathering information from claimants, witnesses, and relevant documentation.
- Determining coverage and issuing judgement on benefit entitlement.
- Investigating claims thoroughly and comprehensively, addressing all liability issues. Reviewing and analyzing various reports and documentation to determine coverage applicability and any possible exclusions.
- Prepare large-loss files for panel discussion and review with leadership teams to supply adequate information in identifying risks and accurately amending reserves to reflect the associated risk.
- Settling claims within office authority and following company guidelines on claim settlements for amount(s) exceeding the office and Adjuster authority.
Senior Accident Benefits Adjuster, Critical Claims
Allstate Insurance
Markham, Ontario
03.2025 - Current
- Evaluated claims to determine eligibility for statutory accident benefits limitations and compliance with policy guidelines.
- Analyzed documentation to ensure accuracy and completeness of claims submissions.
- Coordinated communication between claimants, healthcare providers, and legal representatives to facilitate timely resolutions.
- Reviewed medical records and reports to assess impact on claims processing decisions.
- Implemented data tracking systems for monitoring claim trends and identifying areas for operational improvement.
- Managed high caseloads effectively, prioritizing claims based on urgency and complexity while maintaining attention to detail.
- Maintained a high level of professionalism and confidentiality when handling sensitive information pertaining to claimants' medical history, financial status, and personal circumstances.
- Negotiated settlements between parties involved in accidents, mediating disputes and facilitating fair resolutions.
Education
Health Information Management -
George Brown College
Toronto, Ontario, Canada06-2026
Medical Technology - undefined
Northern Caribbean University
Mandeville, Jamaica06-2011
Skills
- Claims Investigation
- Policy Analysis
- Risk Assessment
- Clinical and Medical Underwriting
- Data Management
- Incident Management
- Customer Service
- Vendor Coordination
- Mediation and Negotiation
- Report Writing
- Technical Troubleshooting
- Training and Development
- Legal Documentation
- Medical Data Compilation
- Health Information Management
- Statistical Analysis
- Regulatory Compliance
- Process Improvement
- Team Leadership
- Microsoft Office Suite
- ServiceNow
- Critical thinking
- Claims investigation
- Advanced oral and written communication skills
Certification
- Chartered Insurance Professional (CIP)
- Toronto, Ontario, Insurance Institute of Canada (ongoing pursuance) | April 2019 – Present
Timeline
Senior Accident Benefits Adjuster, Critical Claims
Allstate Insurance
03.2025 - Current
Senior Accident Benefits Claims Adjuster
Sedgwick CMS Canada
08.2023 - 03.2025
Intermediate Accident Benefits Claims Adjuster
Northbridge Insurance
03.2020 - 08.2023
Accident Benefits Claims Adjuster
Peel Mutual Insurance
09.2018 - 03.2020
Medical Technology - undefined
Northern Caribbean University
Health Information Management -
George Brown College