Theodora Sagoe
Grand Prairie,TX
Summary
Organized and self motivated Claim Adjuster with 3 years of experience, managing a high volume of Workers Compensation and property claims. Effective at interviewing claimants, compiling records with due diligence and documenting findings. Adept at handling workers' compensation claims with strong skills in analyzing claims exposure, litigation, and providing exceptional customer service.
Overview
3
3
years of professional experience
Work History
Independent Property Claims Examiner
Allcat Claims Service
06.2023 - 04.2024
- Made prompt contact with insured to set expectations, develop action plan, and perform initial claim exposure.
- Interviewed insured, reviewed loss details, explained named peril, long term water damages and mechanical damages to policy holders for fair settlements on claim resolutions, customer satisfaction and excellent cost management.
- Confirmed coverage of each claim by reviewing policy endorsements and exclusions to make coverage determination.
- Coordinated with Temporal Housing Companies to relocate policy holders during remediation.
- Processed Additional Living Expenses.
- Reviewed General Loss Report, photos and estimate from Field Adjusters for claim resolution and payment.
- Managed assignments with program and non-program vendors for Water Mitigation, Temporal Housing, and reconstruction.
- Responded to 30 phone calls from policyholders, agents, and other stakeholders regarding claim status .
- Made recommendations to management for settlement amounts outside of authority limits.
- Provided guidance and support to new adjusters, assisting with difficult cases and professional development.
Independent Property and Workers' Compensation Claims Adjuster
CNC Catastrophe & National Claims
12.2021 - 07.2023
- Investigated First Notice of Loss files, reviewed General Loss Reports from Field Adjusters to accurately determine coverage of claims.
- Maintained diary of pending files and updated information to ensure record of claims to monitor progress for next action on claims.
- Managed and coordinated with vendors, field adjusters, insured representation experts, emergency repair services, and various restoration services.
- Conducted day-to-day administrative tasks to maintain information files and process paperwork.
- Analyzed information gathered by investigation and reported findings and recommendations to SIU when needed.
- Negotiated with Public Adjusters and Attorneys for claim settlement and General Release.
- Contacted employers for initial investigation of injury with appropriate forms.
- Interviewed and recorded injured employee and determined appropriate coverage for workers' compensation claims, while providing exceptional customer service throughout life cycle of claim.
- Set appropriate reserves regarding severity of injury.
- Reviewed medical reports and bills to ensure appropriate and necessary treatment.
- Negotiated settlements with claimants and attorneys, achieving favorable outcomes for all parties.
- Closed claim files upon completion of final payment in compliance with state regulations and company policies.
- Provided superior customer service by responding to emails and live phone calls.
- Secured 80% of client satisfaction.
Independent Workers' Compensation Claims Adjuster
Adjuster Source 101
06.2021 - 11.2021
- Actively managed over 150 open workers compensation claims from inception to resolution.
- Examined claim forms, employer First Report of Injury forms, police reports, medical records to determine insurance coverage.
- Interviewed and recorded claimants, witnesses, employers, providers
- Assigned surveillance to investigate questionable claims.
- Maintained communication with claimants Physicians and Attorneys to determine treatment status.
- Authorized changes in medical providers, medical management, rehabilitative services, vocational training or other procedures or services.
- Provided temporary disability payments and monitored cases for continuation of benefits.
- Collected information to complete state filing and legal files toward Settlement.
- Substantiated legitimate claims and denied unjustified claims under required State laws.
Independent Property Claims Adjuster
Pilot Catastrophe Services
03.2021 - 05.2021
- Examined claims forms and other records to determine insurance coverage.
- Assisted policyholders throughout claims process, providing clear explanations of procedures and coverage.
- Scoped damages on live video with insured, took photos and verbal description of damages. Achieved 20% reduction in claim processing time by streamlining workflow and implementing new digital tools.
- Maintain up-to-date knowledge of industry trends, regulations, and best practices to ensure compliance and improve service quality.
- Enhanced client satisfaction by efficiently settling property claims through accurate assessment and negotiation
- Assisted homeowners by coordinating with vendor services, for emergency mitigation and repair.
- Consistently met performance metrics, including customer satisfaction scores and claim resolution times.
- Ensured proper payment calculations by accurately interpreting policy coverage details in relation to individual claim circumstances
Education
Associate - Business Administration
Cambridge International College
St Brelade, Jersey, JE3 8FP, Britain04.1995
Skills
- Workers' Compensation Claims Management
- Claims Investigation and Evaluation
- State Insurance Laws and Regulations
- Customer Service and Active Listening
- Claims Resolution and Negotiation
- Fraud Prevention
- Policy Interpretation
- Attention to Detail
- Time Management
- Estimating Software(Xactimate/ Symbility)
- Software Proficiency (Claims Management System, Guidwire, MS Office Suite)
Professional certification
- 2612485, Adjuster ( Adjuster - All Lines ), The Institutes', 900558209, 2023
- Certified Risk and Compliance Management Professional (CRCMP#362940), International Association of Risk and Compliance Professionals (IARCP)
Active Sate Licenses
TX LA MS AL GA SC NC FL KY WV IN RI CT DE NH VT MI MN OK WY NM AZ ID NV AK OR WA
Timeline
Independent Property Claims Examiner
Allcat Claims Service
06.2023 - 04.2024
Independent Property and Workers' Compensation Claims Adjuster
CNC Catastrophe & National Claims
12.2021 - 07.2023
Independent Workers' Compensation Claims Adjuster
Adjuster Source 101
06.2021 - 11.2021
Independent Property Claims Adjuster
Pilot Catastrophe Services
03.2021 - 05.2021
Associate - Business Administration
Cambridge International College
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