Tara Mills
San Antonio,TX
Summary
Motivated claims professional with 16 years of administrative, customer service, and liability/ injury claims experience. Flexible, innovative, confident, and capable of developing new ideas and concepts while being a leader that seamlessly adapts to change. Seeking a position within a flourishing organization to grow professionally, strengthen core attributes, and become an active community difference-maker.
Overview
21
21
years of professional experience
1
1
Certification
Work History
Claims Specialist
State Farm
06.2023 - Current
- Manages a high volume of injury/liability and litigation claims by effectively prioritizing tasks, completing thorough investigations, maintaining reserves, and providing quality and detailed oriented customer service skills.
- Develops strong working relationships with external partners such as adjusters, legal counsel, and medical professionals including subrogation of property damages toward an efficient claim resolution process.
- Leverages strong negotiation skills to resolve claim disputes, resulting in favorable settlements for both the company and policyholders.
- Collaborates with medical professionals to review injury claims, ensuring proper treatment plans were in place and accurately calculating compensation based on severity and long-term impact.
- Reduced backlogs of pending claims using effective time-management strategies such as prioritizing tasks based on urgency or complexity levels.
- Collaborates with legal teams to represent the company in litigation cases, leading to favorable outcomes in complex claim disputes.
Resolution Manager
Gallagher Bassett
09.2022 - 06.2023
- Handles claims in accordance with any statutory, regulatory, and ethics requirements third-party administrator for commercial claims using high service-oriented file handling.
- Investigate, evaluate, dispose, and settle claims with moderate supervision. Duties include determination and evaluation of coverage, liability, damages, and setting proper reserves.
- Analyze information, determines the extent of liability by using proper judgment and decision-making to analyze claims exposure, and settle claims while maintaining open/closure rate of 98%.
- Conducted thorough investigations to identify subrogation opportunities and gather supporting evidence.
- Utilized analytics tools to evaluate claim data patterns and best practiesnfor better identification of potential subrogation targets.
Injury Adjuster
USAA Insurance
03.2019 - 09.2022
- Adjusted Liability/Bodily Injury/First Party claims for all 50 states.
- Identified, set reserves, confirmed, made coverage decisions on moderately complex bodily injury claims or catastrophic PIP/MP medical claims by reviewing bills, records and issuing payments for bills, wage loss, or essential services.
- Used advanced knowledge of medical and coding terminology. Scheduled peer reviews/ Independent Medical Exam 's when necessary to determine the need for continued treatment or determine maximum medical improvement and Medicare liens.
- Set proper expectations with members & attorneys regarding state specifics and the billing audit process for each state’s statute of limitations by phone, fax, chat or email.
- Maintained customer service quality metrics score of 97%. Member of special engagement committee to address the need for increased KPI metrics within our department. Reached goal of 85% improvement overall.
Legal Case Manager
Law & Order Record Retrieval
07.2017 - 03.2019
- Responsible for assisting litigation firms: plaintiffs and defense, by obtaining all types of records needed for discovery, meditations, or trial
- Experience with affidavits, subpoenas, e-filing, Texas Rules of Civil Procedure, Rule 11s, and motions to quash. Interacted with insureds, attorneys, public adjusters, and forensic experts.
Senior Casualty Adjuster
CSAA Insurance Group
08.2009 - 06.2017
- Evaluated and resolved moderate to severe, fatal, bodily injury claims with prompt review and response to all demands, by represented or non-represented claimants including time limit demands
- Applied understanding of insurance policies and policy interpretation by investigating, providing coverage recommendations, drafting coverage, reservation of rights, and denial letters
- Worked with expert witnesses, attorneys, underwriting department staff, investigators, vendors, and carrier examiners to conduct investigations, confirm findings, and support evaluations
- Delivered quality presentations for high exposure cases to upper claims management for claim exposures over $25,000.
Assistant Team Leader
Premiere Global Services
08.2003 - 07.2009
- Obtained several years of supervisory experience
- Ensured Quality assurance, created knowledge-based learning system for continuing education
- Established a positive and productive work environment, reduced turnover, and increased productivity.
Education
No Degree - Health Information Technology
ST. PHILLIPS COLLEGE
San Antonio, Texas05.2027
Skills
- Supervisory Experience
- Detailed & Quality Oriented
- Advanced critical thinking, negotiation, analytical, and time management skills
- Enrolled in Readytowork SA progam
- Knowledge of Texas Tort Claims Act
- Arbitrator for Arbitration Forums
- Remote/Tele-work Experience
- Microsoft Office Applications/Windows/Mac
- Grant Writing
- Policy Coverage Determinations
- Medical Terminology
- Litigation Resolution
- Underwriting Knowledge
Certification
- AIC- in progress
- SCLA- in progress
- Property & Casualty Adjuster Licensed all 50 states
- Toastmasters Advanced Communicator Bronze
- Toastmasters Advanced Leader Communicator Bronze
- Texas Notary Public
Timeline
Claims Specialist
State Farm
06.2023 - Current
Resolution Manager
Gallagher Bassett
09.2022 - 06.2023
Injury Adjuster
USAA Insurance
03.2019 - 09.2022
Legal Case Manager
Law & Order Record Retrieval
07.2017 - 03.2019
Senior Casualty Adjuster
CSAA Insurance Group
08.2009 - 06.2017
Assistant Team Leader
Premiere Global Services
08.2003 - 07.2009
No Degree - Health Information Technology
ST. PHILLIPS COLLEGE
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