TIMIKA L. POLK
North Richland Hills,TX
Summary
To obtain a position in a field where I may utilize and enhance my professional skills and to obtain the knowledge needed to be successful in every aspect of the job.
Overview
19
19
years of professional experience
1
1
Certification
Work History
Independent Claims Adjuster
Eberls Claims Service
06.2021 - Current
- Evaluated insurance policies and analyzed damages to determine coverage.
- Prepared summaries of damage, payments, and policy coverage.
- Established relationships with clients and insurance companies to foster timely claims resolution.
- Answered customer questions regarding deductibles.
- Examined claims forms and other records to determine insurance coverage.
- Verified insurance claims and determined fair amount for settlement.
- Negotiated with policyholders and claimants to reach mutually satisfactory resolutions.
- Researched and analyzed policy contracts to verify proper payment of claims.
- Documented all investigation activity and presented reports to management.
- Reviewed police reports, medical treatment records, and physical property damage to determine extent of liability.
- Substantiated legitimate claims and denied unjustified claims.
- Conducted comprehensive interviews of witnesses and claimants to gather facts and information.
- Mitigated risks and increased profitability with well-developed strategies for reducing future claims and costs.
- Maintained suspicious claims database and prepared reports for supervisors.
- Delivered exceptional customer service to policyholders by communicating important information and patiently listening to issues.
- Read over insurance policies to ascertain levels of coverage and determine whether claims would receive approvals or denials.
- Conducted day-to-day administrative tasks to maintain information files and process paperwork.
- Identified insurance coverage limitations with thorough examinations of claims documentation and related records.
- Researched claims and incident information to deliver solutions and resolve problems.
- Reviewed and analyzed suspicious and potentially fraudulent insurance claims.
- Analyzed information gathered by investigation and report findings and recommendations.
- Resolved complex, severe exposure claims using high service oriented file handling.
- Investigated and assessed damage to property and reviewed property damage estimates.
- Reviewed new files to determine current status of injury claim and to develop plan of action.
- Analyzed information gathered by investigation and reported findings and recommendations.
- Determined liability outlined in coverage and assessed documentation such from police and healthcare providers to understand damages incurred.
- Maintained contact with claimants and attorneys to determine treatment status.
- Clarified coverage of losses to policyholders and provided assistance in itemizing damages and finding alternative living arrangements.
- Maintained claims data in CCC systems.
- Reviewed questionable claims by conducting agent and claimant interviews to correct omissions and errors.
- Collected evidence to support contested claims in court.
Independent Adjuster
Prime Consulting Group
08.2016 - 06.2021
- Conducted interviews, gathered detailed information and completed field investigations
- Investigated any potentially fraudulent claims with a focus on thoroughness, quality and cost control
- Identified and collected evidence and determined its value to a specific claim
- Conducted claim and estimate re-inspections
- Recommended settlement offers and negotiated payment arrangements
- Kept up-to-date on changes in regulations for deductibles and collections
- Investigated claims, conducted field audits, determined losses and reported findings
- Completed required investigations on referred files in a timely manner.
Customer Service Lead
Arkansas Blue Cross and Blue Shield
04.2006 - 08.2016
- Successfully managed the activities of 15 team members in office and at home
- Created training manuals targeted at resolving even the most difficult customer issues
- Recruited, managed and mentored an average of 50 new customer service representatives per year
- Owned team productivity metrics
- Improved service quality and increased sales by developing a strong knowledge of company's products and services
- Interviewed, hired and trained new quality customer service representatives
- Provided detailed monthly departmental reports and updates to senior management
- Addressed negative customer feedback immediately
- Provided a high level of product and leadership support to representatives and clients
- Routinely prepared and evaluated CRM reports to identify problems and areas for improvement
- Effectively communicated with team members to maintain clearly defined expectations
- Effectively managed departmental expenses to stay within allocated budget
- Collected, monitored and evaluated customer requirements to achieve desired delivery time and order fill rates
- Resolved customer questions, issues and complaints
- Generated and distributed daily reports and order acknowledgments to appropriate personnel
- Lead on and off-site customer support teams across multiple time zones.
Education
Independent Adjuster -
American Adjuster Academy
Dallas,TX,10.2015
Nursing
University of Arkansas Community College
Morrilton, Little Rock, AR2005
Diploma - Medical Assistant & Phelbotomy
Eastern College of Health Vocations
Little Rock, AR06.1998
Licensed Cosmetology - Cosmetology
Conway Beauty Academy
Conway, AR01.1995
Skills
- Microsoft Word
- Case Management
- Data Analysis
- Liability Determinations
- Claims File Management Processes
- Medical Terminology
- Claims Understanding
- Risk Management
- Insurance Policy Coverage Knowledge
- Commercial Property
- Corporate Policies and Procedures
- TX Claims Adjuster License
Certification
- Fire Certification, State Farm - 10-2015
- Auto Certification, State Farm- 10-2015
Timeline
Independent Claims Adjuster
Eberls Claims Service
06.2021 - Current
Independent Adjuster
Prime Consulting Group
08.2016 - 06.2021
Customer Service Lead
Arkansas Blue Cross and Blue Shield
04.2006 - 08.2016
Independent Adjuster -
American Adjuster Academy
Nursing
University of Arkansas Community College
Diploma - Medical Assistant & Phelbotomy
Eastern College of Health Vocations
Licensed Cosmetology - Cosmetology
Conway Beauty Academy
Similar Profiles
Billie HaasBillie Haas
Trainer Manager at Eberls Claim ServiceTrainer Manager at Eberls Claim Service
KIMBERLY CHOWDHURYKIMBERLY CHOWDHURY
Executive General Adjuster at DYNAMIC CLAIMS ADMINISTRATIVE SERVICES, LLCExecutive General Adjuster at DYNAMIC CLAIMS ADMINISTRATIVE SERVICES, LLC
La'Brendrea MillerLa'Brendrea Miller
Independent Property Adjuster and Prelitigation at State Farm Insurance/Eberls ClaimsIndependent Property Adjuster and Prelitigation at State Farm Insurance/Eberls Claims
Kyliah LevensKyliah Levens
Pet Sitter at Shomunny Kennels LLCPet Sitter at Shomunny Kennels LLC
Zachary HazzardZachary Hazzard
ServiceTech/CSR at Scoop Soldiers (Red Poo LLC)ServiceTech/CSR at Scoop Soldiers (Red Poo LLC)