Summary
Overview
Work History
Education
Skills
Certification
Licensing
Timeline
Generic

Tofanya Craig-Tate

Las Vegas,NV

Summary

Claims Examiner with deep knowledge of the Insurance claims industry. Solid abilities in developing objectives and strategies to settle claims. Excellent skills compiling, coding, categorizing and auditing information to process claims.

Overview

19
19
years of professional experience
1
1
Certification

Work History

Commercial Claims Examiner (Contract/Frontline)

Signature Adjustment Group
10.2022 - 12.2023
  • Verify facts of loss and pertinent information to analyze and confirm coverage
  • Establish ultimate reserves (anticipated cost to bring the file to closure based on known facts) as soon as practical and monitor to adjust at the time of any exposure-changing event
  • Explain and appropriately respond to insured, public adjusters, attorneys, and contractors during telephone contacts; as well as contact the appropriate parties to obtain any needed information, provide timely investigation status updates, and explain settlements and/or ultimate claim disposition
  • Timely submit reserve and payment approval requests, as appropriate
  • Identify claims requiring a Reservation of Rights and refer for management approval
  • Draft denial letters for management approval
  • Identify and refer claims with subrogation potential to the subrogation department
  • Identify and refer cases with potential NICB fraud indicators
  • Virtually investigate and resolve claims, as appropriate, with the use of video technology
  • Close all files as appropriate in a timely and complete manner
  • Strictly adhere to Best Practices and operational guidelines, as well as all statutory requirements
  • Interfaces with company clients, carriers, adjusters, or covered parties
  • Communicate with agents regarding the status of the claim
  • Completes and/or reviews, approves, or elevates reservation of rights letters, payment explanation correspondence, denial letters, or partial denial letters, as applicable
  • Resolves disputes regarding claims resolution
  • Responsible for reopening and re-evaluating claims, as necessary.
  • Handled sensitive information with discretion, ensuring confidentiality of personal and financial details for claimants throughout the claims examination process.
  • Reduced claim processing time by implementing efficient workflow strategies and prioritizing tasks effectively.
  • Maintained detailed records of all claims activities, ensuring compliance with regulatory requirements and company policies.
  • Interpreted policy provisions, endorsements, and exclusions to accurately determine coverage for claims.
  • Researched claims and incident information to deliver solutions and resolve problems.
  • Provided exceptional customer service by empathetically addressing claimants'' concerns and effectively explaining the claims process to them.
  • Maintained current knowledge of industry developments, regulations, and best practices through continuous professional development activities.
  • Examined photographs and statements.
  • Mitigated fraud risks by identifying suspicious patterns in claims data and escalating concerns to appropriate teams for further investigation.
  • Negotiated settlements with claimants'' attorneys when needed, achieving favorable outcomes for both parties while minimizing costs.
  • Conducted thorough investigations of complex claims, gathering relevant documentation and interviewing witnesses when necessary.
  • Interviewed claimants and witnesses to gather factual information.
  • Handled complaints and grievances using negotiating and problem-solving skills.
  • Managed caseloads effectively while maintaining high-quality work standards and meeting strict deadlines consistently.
  • Collaborated with insurance adjusters to expedite claim settlements, ensuring fair resolutions for all parties involved.
  • 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.
  • Examined claims forms and other records to determine insurance coverage.
  • Identified insurance coverage limitations with thorough examinations of claims documentation and related records.
  • Delivered exceptional customer service to policyholders by communicating important information and patiently listening to issues.
  • Followed up with insured individuals regarding premium and deductibles payments.
  • Identified suspicious losses and contacted manager for investigative assistance.
  • Evaluated original investigation reports and documents to resolve secondary concerns.
  • Clarified coverage of losses to policyholders and provided assistance in itemizing damages and finding alternative living arrangements.

Desk Adjuster/Remote

Barrett Claims Management (FIGA Contract)
10.2019 - 12.2023
  • Processing insolvent/liquidated claims from insolvent companies
  • Enter claim payments, reserves, and new claims on a computer system, inputting concise yet sufficient file documentation
  • Resolve complex, severe exposure claims for wind, hail, and water, using high service-oriented file handling
  • Maintain claim files, such as records of settled claims and an inventory of claims requiring detailed analysis
  • Trains new adjusters and reviews files for payment and corrections
  • Verify and analyze data used in settling claims to ensure that claims are valid and that settlements are made according to company practices and procedures
  • Examine claims investigated by insurance adjusters, further investigating questionable claims to determine whether to authorize payments
  • Confer with Attorneys, Public Adjusters, and contractors on claims being represented or Assignment of Benefits
  • Report overpayments, underpayments, and other irregularities, as well as supplemental payments
  • Revise estimates in Xactimate to work and issue supplements
  • Investigate, evaluate, and settle claims, applying technical knowledge and human relations skills to effect fair and prompt disposal of cases and to contribute to a reduced loss ratio
  • Pay and process claims within the designated authority level
  • Correct/Adjust estimates submitted by Field Adjusters by photos provided with substantiate damages
  • Adjust reserves and provide reserve recommendations to ensure reserving activities consistent with corporate policies
  • Utilization of the Claim Center to process claims handling accordingly.

Desk Adjuster

Lozano Insurance Adjusters (Citizens of Florida)
10.2017 - 06.2019
  • Entered claim payments, reserves, and new claims on a computer system, inputting concise yet sufficient file documentation
  • Resolved complex, severe exposure claims, using high service-oriented file handling
  • Maintained claim files, such as records of settled claims and an inventory of claims requiring detailed analysis
  • Verified and analyzed data used in settling claims to ensure that claims were valid and that settlements were made according to company practices and procedures
  • Examined claims investigated by insurance adjusters, further investigating questionable claims to determine whether to authorize payments
  • Conferred with legal counsel on claims requiring litigation
  • Reported overpayments, underpayments, and other irregularities, as well as supplemental payments
  • Investigated, evaluated, and settled claims, applying technical knowledge and human relations skills to effect fair and prompt disposal of cases and to contribute to a reduced loss ratio
  • Paid and processed claims within the designated authority level
  • Corrected/Adjusted estimates submitted by Field Adjusters by photos provided with substantiated damages
  • Adjusted reserves and provided reserve recommendations to ensure reserving activities consistent with corporate policies
  • Utilized Guidewire to process claims handling accordingly.
  • Improved claim processing efficiency by streamlining workflows and implementing time-saving strategies.
  • Developed strong relationships with policyholders by providing exceptional customer service throughout the claims process.
  • Consistently met or exceeded performance metrics, demonstrating a strong commitment to excellence in desk adjusting work.
  • Evaluated damages and handled claim negotiations with insureds, claimants, attorneys and public adjusters.
  • Effectively managed claim expenses by accurately estimating repair costs and utilizing cost-effective solutions when possible.
  • Responded to customer inquiries, made appropriate decisions and closed files.
  • Reduced errors in claims handling by conducting thorough investigations and consistently verifying information accuracy.
  • Managed high-volume caseloads to ensure rapid resolution for clients and maintained customer satisfaction levels.
  • Used prescribed guidelines or policies in analyzing situations.
  • Maintained compliance with industry regulations while ensuring accurate documentation of all claim files.
  • Examined claims forms and other records to determine insurance coverage.
  • Verified insurance claims and determined fair amount for settlement.
  • Prepared summaries of damage, payments, and policy coverage.
  • Negotiated with policyholders and claimants to reach mutually satisfactory resolutions.
  • Mitigated risks and increased profitability with well-developed strategies for reducing future claims and costs.
  • Identified insurance coverage limitations with thorough examinations of claims documentation and related records.
  • 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.
  • Researched claims and incident information to deliver solutions and resolve problems.
  • Identified suspicious losses and contacted manager for investigative assistance.
  • Clarified coverage of losses to policyholders and provided assistance in itemizing damages and finding alternative living arrangements.

File Reviewer

Hollins & Associates (Remote/Contract)
10.2015 - 09.2017
  • Conducted interviews with the insured, gathered detailed information, and corresponded with field adjusters
  • Reviewed daily and flood claims with a focus on thoroughness, quality, and cost control
  • Assisted adjusters with administrative tasks
  • Obtained all necessary information to complete proper evaluation of claims
  • Completed required investigations on referred files promptly
  • Monitored the quality of independently conducted investigations
  • Audited claims files for mistakes and corrections needed in VCA
  • Drafted statement of loss to summarize damages, payments, and underlying policy coverage.

Accountant

Wms & Co./Prestige Tax & Accounting Services
01.2013 - 04.2024
  • Sets up small business formation and provides consultation services
  • Prepares current year and past due taxes
  • Provides IRS Representation for clients who have been audited or owe money
  • Manages Accounts Receivable and Accounts payable for the company and clients
  • Processes sales and use tax with the Georgia Department of Revenue
  • Processes payroll and invoices for the company and clients
  • Prepares profit and loss statements for clients
  • Provides Bookkeeping for monthly clients with small businesses
  • Utilizes QuickBooks and other tax preparation software.

Real Estate Agent/Property Manager

Platinum Real Estate/Ambassador Realty/PALS Realty/ReMax/Alpine Properties
07.2005 - 01.2019
  • Leased single-family homes, condos, and luxury apartments to increase business and provide proper housing
  • Provided excellent customer service by assisting residents with issues and concerns
  • This includes consistent follow-ups with tenants, vendors, and maintenance
  • Marketed for prospective leads, sales, and rentals
  • Walked through with property field adjusters once the claim was filed
  • Completed investigations for potential tenants by running credit and background checks to ensure prospect meets the requirements
  • Handled property sales, foreclosures, traditional sales, short sales, and loan modifications.
  • Managed contracts, negotiations, and all aspects of sales to finalize purchases and exceed customer expectations.
  • Negotiated, facilitated, and managed real estate transactions.
  • Advertised client properties through websites, social media, and real estate guides.
  • Maintained connections with clients to encourage repeat business and referrals.
  • Developed and maintained relationships with clients through networking, postcards, and cold calling.
  • Streamlined communication between all parties involved in transactions, ensuring smooth closings and satisfied clients.
  • Communicated with clients to understand property needs and preferences.
  • Developed strong relationships with mortgage brokers, attorneys, and other professionals to streamline the home buying process for clients.
  • Advised clients on market conditions and property value for informed decision-making.
  • Consulted with homeowners on appropriate listing prices based on extensive comparative market analysis, resulting in faster sales and satisfied clients.
  • Presented purchase offers to sellers for consideration.
  • Successfully managed multiple offers for sellers, securing the best possible outcome in each situation.
  • Marketed and sold property for clients by hosting open houses and advertising online and in print.
  • Wrote listings detailing and professionally highlighting property features to increase sales chances.
  • Consistently stayed up-to-date on industry trends and best practices, attending professional development courses and seminars to better serve clients.
  • Reviewed market research data and changed sales plans accordingly.

Desk Adjuster

CRU (Citizens/Contract)
01.2022 - 06.2022
  • Entered claim payments, reserves, and new claims on a computer system, inputting concise yet sufficient file documentation
  • Resolved complex, severe exposure claims, using high service-oriented file handling
  • Maintained claim files, such as records of settled claims and an inventory of claims requiring detailed analysis
  • Verified and analyzed data used in settling claims to ensure that claims were valid and that settlements were made according to company practices and procedures
  • Examined claims investigated by insurance adjusters, further investigating questionable claims to determine whether to authorize payments
  • Conferred with legal counsel on claims requiring litigation
  • Reported overpayments, underpayments, and other irregularities, as well as supplemental payments
  • Investigated, evaluated, and settled claims, applying technical knowledge and human relations skills to effect fair and prompt disposal of cases and to contribute to a reduced loss ratio
  • Paid and processed claims within the designated authority level
  • Corrected/Adjusted estimates submitted by Field Adjusters by photos provided with substantiated damages
  • Adjusted reserves and provided reserve recommendations to ensure reserving activities consistent with corporate policies
  • Utilized Guidewire to process claims handling accordingly.
  • Improved claim processing efficiency by streamlining workflows and implementing time-saving strategies.
  • Developed strong relationships with policyholders by providing exceptional customer service throughout the claims process.
  • Consistently met or exceeded performance metrics, demonstrating a strong commitment to excellence in desk adjusting work.
  • Evaluated damages and handled claim negotiations with insureds, claimants, attorneys and public adjusters.
  • Investigated origin and cause of claims by contacting appropriate parties.
  • Effectively managed claim expenses by accurately estimating repair costs and utilizing cost-effective solutions when possible.
  • Responded to customer inquiries, made appropriate decisions and closed files.
  • Reduced errors in claims handling by conducting thorough investigations and consistently verifying information accuracy.
  • Managed high-volume caseloads to ensure rapid resolution for clients and maintained customer satisfaction levels.
  • Used prescribed guidelines or policies in analyzing situations.
  • Performed extensive research into policy coverage details for accurate application within each unique case scenario.
  • Maintained compliance with industry regulations while ensuring accurate documentation of all claim files.
  • Examined claims forms and other records to determine insurance coverage.
  • Answered customer questions regarding deductibles.
  • Verified insurance claims and determined fair amount for settlement.
  • Prepared summaries of damage, payments, and policy coverage.
  • Documented all investigation activity and presented reports to management.
  • Established relationships with clients and insurance companies to foster timely claims resolution.
  • Evaluated insurance policies and analyzed damages to determine coverage.
  • Substantiated legitimate claims and denied unjustified claims.
  • Delivered exceptional customer service to policyholders by communicating important information and patiently listening to issues.
  • Identified insurance coverage limitations with thorough examinations of claims documentation and related records.
  • Followed up on potentially fraudulent claims initiated by claims representatives.

Desk Adjuster

IAS Claims Service (Citizens of Louisiana)
08.2021 - 12.2021
  • Enter claim payments, reserves, and new claims on a computer system, inputting concise yet sufficient file documentation
  • Resolve complex, severe exposure claims for wind, hail, and water, using high service-oriented file handling
  • Maintain claim files, such as records of settled claims and an inventory of claims requiring detailed analysis
  • Verify and analyze data used in settling claims to ensure that claims are valid and that settlements are made according to company practices and procedures
  • Examine claims investigated by insurance adjusters, further investigating questionable claims to determine whether to authorize payments
  • Revise estimates in Xactimate to work and issue supplements
  • Investigate, evaluate, and settle claims, applying technical knowledge and human relations skills to effect fair and prompt disposal of cases and to contribute to a reduced loss ratio
  • Pay and process claims within the designated authority level
  • Correct/Adjust estimates submitted by Field Adjusters by photos provided with substantiate damages
  • Adjust reserves and provide reserve recommendations to ensure reserving activities consistent with corporate policies
  • Utilization of the Claim Center to process claims handling accordingly.

Desk Adjuster

Worley/NCA (ASI Progressive)
07.2019 - 09.2019
  • Entered claim payments, reserves, and new claims on a computer system, inputting concise yet sufficient file documentation
  • Resolved complex, severe exposure claims for wind, hail, and water, using high service-oriented file handling
  • Maintained claim files, such as records of settled claims and an inventory of claims requiring detailed analysis
  • Verified and analyzed data used in settling claims to ensure that claims were valid and that settlements were made according to company practices and procedures
  • Examined claims investigated by insurance adjusters, further investigating questionable claims to determine whether to authorize payments
  • Conferred with Attorneys, Public Adjusters, and contractors on claims being represented or Assignment of Benefits
  • Reported overpayments, underpayments, and other irregularities, as well as supplemental payments
  • Investigated, evaluated, and settled claims, applying technical knowledge and human relations skills to effect fair and prompt disposal of cases and to contribute to a reduced loss ratio
  • Pay and process claims within the designated authority level
  • Corrected/Adjusted estimates submitted by Field Adjusters by photos provided with substantiated damages
  • Adjusted reserves and provided reserve recommendations to ensure reserving activities consistent with corporate policies
  • Utilization of the Claim Center to process claims handling accordingly.
  • Developed strong relationships with policyholders by providing exceptional customer service throughout the claims process.
  • Consistently met or exceeded performance metrics, demonstrating a strong commitment to excellence in desk adjusting work.
  • Evaluated damages and handled claim negotiations with insureds, claimants, attorneys and public adjusters.
  • Responded to customer inquiries, made appropriate decisions and closed files.
  • Reduced errors in claims handling by conducting thorough investigations and consistently verifying information accuracy.
  • Managed high-volume caseloads to ensure rapid resolution for clients and maintained customer satisfaction levels.
  • Used prescribed guidelines or policies in analyzing situations.
  • Collaborated cross-functionally with other departments to address complex issues impacting claims resolution times effectively.
  • Expedited claim settlements with skilled negotiation tactics that led to fair resolutions for all parties involved.
  • Examined claims forms and other records to determine insurance coverage.
  • Answered customer questions regarding deductibles.
  • Verified insurance claims and determined fair amount for settlement.
  • Prepared summaries of damage, payments, and policy coverage.
  • Evaluated insurance policies and analyzed damages to determine coverage.
  • Substantiated legitimate claims and denied unjustified claims.
  • Negotiated with policyholders and claimants to reach mutually satisfactory resolutions.
  • Delivered exceptional customer service to policyholders by communicating important information and patiently listening to issues.
  • Identified insurance coverage limitations with thorough examinations of claims documentation and related records.
  • 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.
  • Researched claims and incident information to deliver solutions and resolve problems.
  • 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.

Total Loss, Complex Claims Adjuster

Pilot Catastrophe (State Farm Auto Contract)
08.2017 - 10.2017
  • Conducted interviews with the insured, gathered detailed information, and corresponded with field adjusters
  • Reviewed daily and auto claims with a focus on thoroughness, quality, and cost control
  • Handled total Loss claims and complex claims from inception to close in multiple jurisdictions
  • Provided quality, timely investigation and adjustment of personal auto property damage through the application of insurance contracts, endorsements, state laws, and regulations
  • Solid working knowledge of automobile and property repair techniques and interpreting written damage appraisals
  • Utilized claim protocol when issuing settlements within authority levels; calculated and issued diminished value; recognized subrogation and salvage issues and moved to appropriate departments; worked under minimal supervision
  • Audited claims files for mistakes and corrections needed.
  • Examined claims forms and other records to determine insurance coverage.
  • Documented all investigation activity and presented reports to management.
  • Verified insurance claims and determined fair amount for settlement.
  • Prepared summaries of damage, payments, and policy coverage.
  • Provided exceptional customer service during emotionally difficult situations for policyholders following accidents or natural disasters.
  • Evaluated insurance policies and analyzed damages to determine coverage.
  • Reviewed police reports, medical treatment records, and physical property damage to determine extent of liability.
  • Managed catastrophic loss events effectively by coordinating rapid response efforts and providing support to impacted policyholders.
  • Improved claim resolution times by efficiently managing a caseload of 50+ claims per month.
  • Reduced processing time for property damage claims by accurately assessing repair costs and negotiating with contractors.
  • Facilitated smooth transitions for policyholders during the claim process by liaising between various departments, ensuring all parties were informed and engaged.
  • Delivered exceptional customer service to policyholders by communicating important information and patiently listening to issues.

Education

Bachelor of Science - Accounting

American Intercontinental University
Schaumburg, IL

Associate of Arts - Business

American Intercontinental University
Schaumburg, IL

Skills

  • Proven ability to learn computer programs quickly
  • Regularly handles confidential and sensitive information
  • Experience in insurance adjusting, with a proven record
  • Works well under pressure
  • Claims File management process
  • Self-Directed
  • Proficient in Xactimate, XactAnalysis, and Symbility
  • Utilization of Guidewire and ECS software
  • Utilization of Epic
  • Utilization of Image Right and Light Speed
  • Utilization of VCA/Virtual Claims Assistant
  • Claims Processing
  • Verbal Communication
  • Data Verification
  • Microsoft Office Suite
  • Computer Skills
  • Claims Evaluation
  • Decision-Making
  • Customer service and support
  • Payment Processing
  • Critical Thinking
  • Team Leadership
  • File and Record Management
  • Claims Investigation
  • MS Office
  • Denied claims identification
  • Coverage Determination
  • Fraudulent Claims Investigation
  • Insurance policy coverage knowledge
  • Negotiation and mediation
  • Legal proceedings knowledge

Certification

  • Cooke Real Estate School and Georgia MLS
  • Real Estate Licensee GA and FL, NV (pending)

Licensing

  • Georgia (Home State) Property & Casualty (Adjuster)
  • FL
  • LA
  • TX
  • OK
  • KY
  • MI
  • WY
  • SC
  • ( NC PENDING)
  • Eagleview/Onsite Field Certification
  • California Earthquake Certification/ California Fair Claims State Farm Auto Independent Adjuster Certification TWIA Certification
  • USAA Field Certification (Field)
  • HCI (Homeowners Choice certification) Tower Hill Certification
  • Canadian Certification Environmental Certification Allstate Field Certification Citizens of Florida Certification Citizens of Louisiana Certification FEMA Badge (Security Clearance)
  • NFIP Adjuster Presentation Certification FCN#0070008463
  • FEMA Public Assistance Certification
  • Xactinalysis ID: TONICRAI@TOFANYA.LITHONIA.GA

Timeline

Commercial Claims Examiner (Contract/Frontline)

Signature Adjustment Group
10.2022 - 12.2023

Desk Adjuster

CRU (Citizens/Contract)
01.2022 - 06.2022

Desk Adjuster

IAS Claims Service (Citizens of Louisiana)
08.2021 - 12.2021

Desk Adjuster/Remote

Barrett Claims Management (FIGA Contract)
10.2019 - 12.2023

Desk Adjuster

Worley/NCA (ASI Progressive)
07.2019 - 09.2019

Desk Adjuster

Lozano Insurance Adjusters (Citizens of Florida)
10.2017 - 06.2019

Total Loss, Complex Claims Adjuster

Pilot Catastrophe (State Farm Auto Contract)
08.2017 - 10.2017

File Reviewer

Hollins & Associates (Remote/Contract)
10.2015 - 09.2017

Accountant

Wms & Co./Prestige Tax & Accounting Services
01.2013 - 04.2024

Real Estate Agent/Property Manager

Platinum Real Estate/Ambassador Realty/PALS Realty/ReMax/Alpine Properties
07.2005 - 01.2019

Bachelor of Science - Accounting

American Intercontinental University

Associate of Arts - Business

American Intercontinental University

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Tofanya Craig-Tate