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
Denver, CO
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