Torchet A. Fulton-White
JP Morgan Chase
Desoto,USA
26
years of professional experience
Experienced Licensed Claims Adjuster with extensive expertise in insurance claims adjusting and mortgage loan underwriting. Demonstrated leadership in problem-solving and collaboration to achieve operational and financial objectives while delivering exceptional service to policyholders and clients.
Work History
Compliance Fraud Auditor
5 Years- Identified and submitted Suspicious Activity Reports (SARs) promptly to management, ensuring compliance with regulatory requirements.
- Investigates referrals of potential suspicious activity to determine if there is a potential fraud risk to the bank.
- Performs complex investigations with various research and investigative software programs and tools.
- Works to detect various fraud schemes (elder abuse, counterfeit checks, with characteristics of red flags
- Communicated fraud situations to business units, customers, and external parties, recommending actionable steps to mitigate risks.
- Executed decisive measures to protect bank assets. to perfect the bank’s assets and minimize losses.
- Established liaison relationships with business units and external investigative agencies to enhance collaboration in fraud investigations.
- Monitors cases filed with law enforcement for disposition of cases.
- Documents the case comments with investigative steps performed with procedures and standards
Bodily Injury Adjuster II
4 Years 2 Months- Administer recorded statements to insureds, claimants, witnesses, medical providers, etc., while conducting investigations into complex auto accidents, determine liability and prepare summaries.
- Thoroughly investigate, negotiate, evaluate and settle moderate to complex bodily injury claims.
- Set up claim reserves while updating the reserves as claim progresses while documenting rationale and claim summary notes to move claim forward.
- Knowledge of medical and legal terminology to complete investigations.
- Manage attorney-represented files, negotiating fair settlements based on claim evidence and impact level guidelines within established claim limits.
- Evaluate the insurance policy coverage to make sure that the policy is in force on date of loss.
- Negotiate a prompt fair bodily injury settlement based on evidence presented in the claim file.
- Pay and process claims within designated authority level; ensuring that reserve activities are consistent with corporate policies.
- Review and issue payments for third party and insured medical treatment and bodily injury claims.
- Investigate medical evidence in claims, assessing whether injuries have been exaggerated based on points of car impacts and presented injuries.
- Interview insured(s), claimant(s) and witnesses to determine liability assessment.
- Collaborated with appraisers to assess collision damages and verify alignment with reported bodily injuries.
- Directed files to appropriate departments for specialized handling and investigation of claims. to appropriate departments including SIU and Outbound Subrogation.
- Obtain all pertinent documents needed for claims investigation, police reports, hospital bills, damage photos, scene investigation.
- Draft and send denial letters along with state specific required letters and documentation.
- Review and issue payments based off sub demands received from adverse carriers.
- Review and document claim handling for pro-rata losses.
Compliance Advocate III
2 Years 2 Months- Conducting compliance risk assessment of new products and initiatives while advising business unit of compliance risk(s) associated risks.
- Support business lines by providing expert advice while influencing changes to processes, procedures, and controls to mitigate compliance risk.
- Providing subject matter expertise and guidance on fair lending consumer compliance requirements.
- Assess operational breakdowns for compliance risk and provide guidance on remediation/recovery plans.
- Identify trends in data and advise on identified emerging risks to company.
- Providing effective challenge and guidance on compliance risks and supporting business line through various interactions and forums.
- Communicate compliance risk appetite and key performance metrics to business line and monitor business plans to ensure compliance risk remains within approved appetite.
- Performing risk-based design reviews of business line controls and providing guidance on identified risks.
- Help business line determine appropriate training audience, delivery channel(s), and training frequency for compliance training.
- Review complaints for compliance risks; provide guidance on remediation; escalate and facilitate with subject matter experts as necessary.
Bodily Injury Adjuster
8 Months- Comply with all statutory and regulatory requirements in all applicable jurisdictions.
- Obtain and review medical records.
- Interview, telephone, and/or correspond with claimant and witnesses; obtains and reviews police hospital records, appraisals and repair estimates to evaluate injuries property damage.
- Reports to client as required by contractual account instructions, varying method of investigation according to type of coverage.
- Identify key issues and investigation required.
- Meet detailed quality assurance standards of performance.
- Obtain and maintain all required licenses and certifications and meet all continuous training and certification requirements.
- Determine extent of the client’s financial exposure with respect to claims; set case reserves for use by clients and regulatory authorities.
- Set reserves based on potential claim amount with supervisor’s approval.
- Settle claims within assigned levels of authority as set forth.
- Handle litigation as it develops.
- Be alert to insurance fraud and implement special procedures if fraud is suspected.
Claims Representative II
1 Year 5 Months- Provided excellent customer service to insurance policy holders as well as all third-party participants that are involved in the claims process.
- Ability to be understanding and be sensitive to the needs and feelings of others while maintaining composure in difficult situations.
- Listened carefully to recorded statements and continuously ask probing for additional details, with targeted questions to gather information about the overall insurance claim.
- Investigated and settle multiple lines of insurance claims of a moderate to severe nature.
- Examined claim forms and other records to determine insurance coverage.
- Utilized various methods of investigation and negotiate settlement with claimants in accordance with prescribed authority.
- Provided direction to lower-level claims adjusters as needed.
- Positively adapt to a rapidly changing claims environment.
- Investigated medical facts to determine the depth of bodily injury and potential workers compensation.
- Resolved claims according to Best Practices within authority limits.
- Communicated with policy holders, third party customers, brokers, attorneys, and management teams within allotted diary timeframe of claim.
- Handled claims for specific accounts or industry segments position requires good organization and communication skills, the ability to work at a fast pace.
- Researched and determined customer needs and determine the most appropriate solution to cure insurance claim based on need.
Auto Claims Representative III
4 Years 2 Months- Examined, evaluated, and investigated auto claims in connection with insurance liability standards based on documented evidence.
- Reviewed all reported losses through a thorough investigation process by interviewing all parties involved in the loss, vehicle inspections and a review of police reports and supporting documentation.
- Evaluated the vehicle damages and determine the practicality of vehicle repair versus vehicle replacement. Process total loss vehicles and review appropriate settlement figures with insureds and claimants.
- Initiated payment actions and make payment adjustments to insurance fund reserves.
- Advised medical providers, claimants, and other stakeholders on rules, procedures, policies, and laws relating to the state insurance programs.
- Selected to handle more challenging claims, including catastrophe events, complex liability, commercial vehicles, and real property damage claims.
- Prepared claim reports and loss statistics reports.
- Conducted complete investigation of losses through any appropriate techniques including interviews, recorded statements, documentation/data gathering and securing/preserving evidence.
- Evaluated liability and damages; identify subrogation/salvage opportunities or suspicious claims.
- Prepared timely, concise reports as required. Promptly establish and maintain accurate reserves.
1 Year 4 Months
- Thorough understanding of mortgage loans.
- Performed detailed knowledge of processing, underwriting techniques and closing procedures.
- Secured loans under conventional, government, and portfolio guidelines.
- Expertise in federal lending regulations governing residential real estate lending.
- Managed pipeline of conventional, government, and portfolio loans.
- Maintained high level of customer service by being proactive in communicating with the borrowers and loan originators.
- Performed collections and related activities on consumer-financed auto accounts in accordance with the company’s standards and guidelines and state and federal law.
- Acquired and developed a solid profitable base of broker/correspondent relationships throughout Dallas/ Tarrant counties.
- Performed delinquency analysis and negotiated payment arrangements with past due borrowers.
- Advised borrowers on various repayment methods.
- Instituted various investigative techniques to locate paying customers.
Claims Adjuster II
10 Months- Established contact with the policyholder within 24 hours of loss assignment.
- Demonstrated appropriate understanding and empathy.
- Collected information from the customer as well as the third parties involved in the claims process.
- Asked appropriate questions and probed to gather required information necessary to adjust the loss.
- Sets medical evaluations and coordinates return to work, interactive process, utilization review, independent medical review, and independent bill review; attends mandatory settlement conferences, hearings, and meetings relevant to cases.
Liability Claims Representative III
1 Year 11 Months- Investigated automobile accidents in the Liability Division of the company.
- Curtailed insurance fraud by deeply investigating behavior clues on recorded statements.
- Evaluated bodily injury claims from car rental customers and claimants.
- Reviewed and analyzed coverage and applied policy conditions, provisions, exclusions, and endorsements in connection with a variety of vehicle damage claims.
- Analyzed multi-jurisdictional issues and applied the applicable state law with respect to claims relating to negligence, financial responsibility limits, and immunity.
- Managed deductible and coverage limits.
- Contacted appropriate parties to obtain relevant facts necessary to determine coverage, causation, damages, nature and extent of injuries and exposure with respect to various vehicle coverage programs.
- Managed file inventory by utilizing an effective diary system and documented claim file activities in accordance with established procedures.
- Determined settlement amounts abased on independent judgment, estimation of actual cash value and replacement value, and independent appraisals.
- Negotiated and conveyed claims settlements.
- Satisfied all quality standards and expectations of the company’s best practices protocol.
Risk Management Asset Control Representative II
1 Year 6 Months- Clarified complex insurance and rental agreement clauses for customers and third parties, enhancing understanding and compliance.
- Acted as customer service liaison for AAA Insurance Company and Enterprise Rent-A-Car.
- Increased accounts receivable collection and mitigated fraudulent insurance claims through targeted surveys and investigative techniques.
- Increased customer satisfaction by developing work plans based on consumer interviews.
- Boosted store revenue by securing new insurance accounts with large contractors in New Jersey and Delaware.
- Maintained paper filing system and electronic database to ensure contracts were timely and fully performed.
Assistant Manager
1 Year 10 Months- Increased profitability by creating business growth plans, designing operational packets for new employees, and identifying critical areas for improving major client relations.
- Oversaw management of rental car fleet of over 160 cars, coordinating maintenance and rental processes to optimize availability.
- Reduced claims response time and decreased customer wait time.
- Developed training program for new employees on regulations, policies, and procedures to ensure compliance and operational efficiency.
Education
Bachelor of Administration - Mass Communications
Master of Business Administration - Global Business
Skills
Audit reporting
Internal auditing
Regulatory compliance
Compliance standards
Financial auditing
Financial reporting
Financial records review
Account reconciliation
Audit plan development
Audit programs and processes
Regulatory filings
Risk assessment
Risk mitigation strategies
Risk mitigation
Decision-making
Process evaluations
Process improvement
Data analytics
Analytical problem solving
Financial statements
Workload management
Attention to detail
Quality assessment
Internal controls
Problem solving
Financial statements expertise
Financial controls
Industry expertise
Business acumen
Team collaboration
Project management
Compliance training
Analytical research
Records review
Audit programs
Relationship building
Training programs
Issue resolution
Critical thinking
Report generation
Workload management
Quality assessment
Analytical research
Fraud analytics
Relationship building
Conflict negotiation and resolution
Non-compliance assessment
Cash analysis
Accounts payable
Financial risk manager (FRM)
Goal development
Timeline
Compliance Fraud Auditor
JP Morgan Chase
08.2021 - CurrentRead More
Bodily Injury Adjuster II
Rodney D. Young Insurance
04.2017 - 06.2021Read More
Compliance Advocate III
Kohl’s Credit Card Services
02.2015 - 04.2017Read More
Bodily Injury Adjuster
Rose International (contract) Access Insurance
06.2014 - 02.2015Read More
Claims Representative II
Texas Farm Bureau
01.2013 - 06.2014Read More
Auto Claims Representative III
AAA/Auto Club Enterprises
11.2008 - 01.2013Read More
HSBC/ Underwriter
06.2007 - 10.2008Read More
Claims Adjuster II
Bristol West Insurance Company
08.2006 - 06.2007Read More
Liability Claims Representative III
Enterprise Rent- A Car Liability Claims Organization (ELCO Claims Department)
09.2004 - 08.2006Read More
Risk Management Asset Control Representative II
Enterprise Rent-A-Car
10.2002 - 04.2004Read More
Assistant Manager
Enterprise Rent-A-Car
12.2000 - 10.2002Read More
Lander University
Bachelor of Administration from Mass Communications
Read More
American InterContinental University
Master of Business Administration from Global Business
Read More