Tenisha Thompson
Duluth,GA
Summary
Results-oriented licensed claims adjuster, with 8 years of diversified experience in claims and operations. Experience ranges from intake, triage, and claims handling to draft account analytics and compliance management. Experienced professional focused on meeting or exceeding objectives. Offers advanced training and knowledge of industry best practices. Recognized for leadership, planning abilities and clear, direct communication style. Focused on performance and flexible with specific needs of different assignments. Collaborates professionally with individuals from broad array of backgrounds and cultures.
Trained in all aspects of insurance billing, claims, operations, and litigation. Analytical thinker and innovative problem solver.
Overview
7
7
years of professional experience
1
1
Certification
Work History
Professional Associate
ESIS, Workers Compensation
Alpharetta, GA
02.2022 - Current
- Evaluates evidence with ultimate goal of creating positive outcomes for client's claims
- Contacts, interviews, and obtains statements from insureds, claimants, witnesses, to secure necessary claim information
- Evaluates facts supplied by investigation to determine extent of liability of insured, if any, and extend company’s obligation to insured under policy contract
- Prepares reports on investigation, settlements, denials of claims, individual evaluation of involved parties, etc.
- Sets reserves within authority limits and recommends reserve changes to Team Leader
- Review progress and status of claims with Team Leader and discuss problems and suggested remedial actions
- Prepares and submits to Team Leader unusual or possible undesirable exposures
- Assists Team Leader in developing methods and improvements for handling claims
- Settles claims promptly and equitably
- Participates in claim file reviews and audits with customer/insured and broker
- Administers benefits timely and appropriately
- Maintains control of claim’s resolution process to minimize current exposure and future risks
- Establishes and maintains strong customer relations.
- Manages over 120 to 160 pending claims
- Conducts comprehensive interviews of witnesses and claimants to gather facts and information
- Reviews field inspections and coordinated all insurance claim audits
- Follow up on potentially fraudulent claims initiated by claims representatives
- Substantiated legitimate claims and denied unjustified claims
Claims Analyst
Chubb Insurance Company, Complex Claims
Alpharetta, GA
12.2020 - 02.2022
- Responsible for intake, triage, and segmentation of complex, long tail exposure claims as well as lawsuits and arbitrations naming Chubb issuing companies and affiliated entities
- Performed initial file work-up, initial contact with customers and business partners, gathering of documents and information necessary to administer claim or litigation, documentation of initial file notes, identification of issues and matters in need of immediate attention by senior claim handlers and segmentation for further handling
- Managed claims administration, identify issues in complex claim matters in need of immediate triage and segmentation to senior adjusters as well as direct experience in handling claim matters of less complex nature
- Managed own workload to service client promptly and efficiently
- Developed working relationships with clients to promote customer satisfaction
- Managed 5-7 new files per day
- Supported 50 Claims Handlers / Claims Manager in administrative cycle of claims handling
Commercial Claims Operations Assistant
Chubb Insurance Company
Alpharetta, GA
05.2017 - 12.2020
- Responsible for, but not limited to; logistics, support, and compliance
- Analyze escheat, duplicate, due diligence, and correction reports and report findings to Chubb draft account team
- Track and analyze various report from draft account to treasury operations and make appropriate corrections
- With minimal supervision, performs varied claims processing, administrative and technical support functions and tasks in multiple claims and policy systems
- Promoted to Claims Operations Assistant in January 2018 after major reorganization effort that is ongoing
- Participates in technical reviews and quality reviews of work performed by Commercial NA Claim Operations outsource vendor and effectively and constructively communicates findings
- Participates in regular audits of partner Vendor and Claim Operations results, processes and workflow to ensure quality, service levels, productivity, and technical metrics are consistently met
- Successfully led key projects which increased efficiency and minimized cost
- Meeting quality standards with 100% accuracy rate
- Consistently meeting 95% SLA based on each task.
CSR Team Lead
ACCC Insurance Company
Alpharetta, GA
04.2015 - 05.2017
- Managed, update, and address 20-30 claims daily
- Determined applicable coverage and processed appraisal assignments
- Identified problems and create solutions for internal and external customers
- Collaborated with internal/external customers to understand requirements and provide exceptional claims service
- Managed quality assurance program including on-site evaluations, internal audits, and customer surveys
- Supervised 8 Intake Specialists in providing excellent customer service to callers requiring assistance for claim and appraisal issues
- Developed team communications and information for intake meetings
- Promoted to Team Lead 04/2016 .
Education
Associate of Applied Science - Business Administration
Georgia State University
Skills
- Compliance
- Reserves Adjustment
- Claims Knowledge
- Cost Control
- File Review
- Settlement Negotiation
- Workers Compensation
- Claims Adjustments
- Claims Evaluations
- Defensive Strategies
- Litigation Management
- Claims Investigations
- Reserves Recommendations
- Proficient in Microsoft Office Suite Word, Excel, Access, PowerPoint
- Exceptional Customer Service and Relationship-Building Skills
Affiliations
Chubb REAP Mentorship Program
State Farm Mentorship Program Hosted by GSU
Certification
Georgia Certified Workers’ Compensation Professional Program - CWCP Designation
Timeline
Professional Associate
ESIS, Workers Compensation
02.2022 - Current
Claims Analyst
Chubb Insurance Company, Complex Claims
12.2020 - 02.2022
Commercial Claims Operations Assistant
Chubb Insurance Company
05.2017 - 12.2020
CSR Team Lead
ACCC Insurance Company
04.2015 - 05.2017
Associate of Applied Science - Business Administration
Georgia State University
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