Trase Moss
PIP/Liability Claims Adjuster
Mulberry,FL
Summary
Detail-oriented adjuster with 24 years of experience, eager to contribute skills and expertise in investigating and processing insurance claims to a reputable organization. Possessing versatile skills in first-party no-fault and liability claims, proficient in analyzing causes, interpreting policies, reviewing medical bills and soap notes, determining coverages, and negotiating payment solutions. Renowned for attention to detail, observational skills, willingness to learn, and helpful nature. Excels in providing excellent interpersonal interactions and maintaining accurate documentation.
Overview
24
24
years of professional experience
Work History
TCRI/PIP Adjuster
GEICO
09.2007 - 04.2024
- Handled no fault PIP files, coverage files, liability files, obtained recorded statements, addressed and handled medical bills, PIP qualifications, reviewed for fraud and set up Independent medical exams, Examinations under oath, PIP demand responses, PIP LIT projects, arbitration responses/contentions/and addressed decisions.
- Accessed claims for bodily injury and uninsured/underinsured motorist exposure. Escalated the claims timely when appropriate.
- Reviewed claims for subrogation potential. (PIP and liability)
- Conducted thorough investigations into complex claims situations, ensuring fair outcomes for all parties involved. Conducted comprehensive interviews of witnesses and claimants to gather facts and information. Obtained police reports, vehicle damage information and any evidence needed to determine liability, injuries, applicable coverages, and PIP qualifications.
- Respond to Letter of Representations.
- Maintained contact with claimants and attorneys to determine treatment status.
- Adhered to strict confidentiality guidelines when handling sensitive client information, maintaining trust among clients and colleagues alike. Maintained confidentiality of patient finances, records, and health statuses.
- Maintained client confidentiality and adhered to HIPAA guidelines.
- Prepared insurance claim forms or related documents and reviewed for completeness.
- Examined claims forms and other records to determine insurance coverage. Assured timely verification of insurance benefits for all applicable parties.
- Reviewed medical bills and soap notes.
- Maintained client confidentiality and adhered to HIPAA guidelines.
- Determined appropriateness of payers to protect organization and minimize risk.
- Posted payments to accounts and maintained records. Accurately handled medical bills.
- Resubmitted claims after editing or denial to achieve financial targets and reduce outstanding debt.
- Provided excellent customer service and attention to customers through all interactions (phone, mail, electronic communications)
- Maintained strong relationships with policyholders, agents, and colleagues by consistently demonstrating professionalism, empathy, and effective communication skills. Efficiently processed and resolved claims in a timely manner.
- Ensured compliance with state regulations and company policies through diligent review of all claim-related materials.
- Assisted clients in understanding their insurance coverage by explaining complex terms and conditions clearly and concisely.
- Improved claim processing efficiency by conducting thorough investigations and promptly addressing discrepancies.
- Investigated damage to property and reviewed property damage estimates. Handled vehicle damages and set up rentals if applicable.
- Reviewed police reports, medical treatment records, and physical property damage to determine extent of liability.
- Negotiated fair settlements on behalf of the company for property damage claims while mitigating financial risk exposure.
- Analyzed information gathered by investigations to report findings and recommendations.
- Leveraged strong negotiation skills to resolve claim disputes, resulting in favorable settlements for both the company and policyholders.
- Managed caseloads and prioritized tasks effectively to meet strict deadlines without compromising on quality or accuracy.
- Participated in ongoing professional development opportunities to maintain current knowledge of insurance laws, regulations, and best practices within the field of claims adjustment.
- Enhanced client satisfaction by providing timely updates and effectively resolving claim disputes.
- Provided exceptional customer service by addressing concerns, answering questions, and explaining complex policy information to clients. Followed up with customers on unresolved issues.
- Negotiated with policyholders and claimants to reach mutually satisfactory resolutions.
- Determined liability outlined in coverage and assessed documentation such from police and healthcare providers to understand damages incurred.
- Analyzed information gathered by investigation and reported findings and recommendations.
- 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.
- Reviewed questionable claims by conducting interviews to correct omissions and errors.
- Monitored claim trends for potential fraud indicators, contributing to the reduction of fraudulent activity within the company.
- Researched claims and incident information to deliver solutions and resolve problems.
- Collected pertinent information from customers to complete claims. Accurately documented and attached information to claim files.
- Maintained claims data in Atlas systems.
- Assisted Supervisors and Managers with arbitration responses for other associates.
- Continuously updated skills through professional development training opportunities, leading to improved job performance.
Telephone Claims Service Representative and Personal Injury -PIP Coach
GEICO
05.2010 - 03.2023
- Assisted with training new hires on company policies, procedures, and best practices for claims handling to ensure a smooth transition into the role.
- I worked closely with new adjusters providing guidance on how to handle coverage files, liability claims, no fault Personal Injury claims, PIP Demand Responses, and Arbitration responses/contentions/and address decisions.
- Helped new adjusters learn the process to complete full liability investigations, obtain recorded statements, Police reports and any evidence needed to determine liability, applicable coverage, and PIP qualifications.
- Helped new adjusters develop strong working relationships with clients, adjusters, and other stakeholders in the claims process, maintain open lines of communication and providing consistent updates on claim status.
- Helped new adjusters develop in-depth understanding of insurance policies and procedures.
- Taught adjusters how to respond to Letter of Representations, how to recognize bodily injury and uninsured/underinsured motorist, and subrogation exposures in order to properly route claims in a timely manner.
- Helped new adjusters demonstrate strong negotiation skills in settling disputes between insured parties and third-party claimants fairly while protecting company interests.
- Contributed to team success by participating in regular training sessions, sharing best practices, and mentoring new adjusters.
- Conducted day-to-day administrative tasks to maintain information files and process paperwork. Responsible for keeping coaching logs, side by sides notes, new loss reviews, file reviews and call monitors.
- Supported team members by sharing expertise and knowledge, fostering collaboration within the department.
- Taught new adjusters how to post payments to accounts and maintained records.
- Taught new adjusters how to review medical bills and soap notes.
- Continued to provide support and education for adjusters even after they completed transition.
- Taught new adjusters how to manage caseloads and prioritized tasks effectively to meet strict deadlines without compromising on quality or accuracy.
- Collaborated with adjusters to ensure accurate claim evaluations and settlements, improving overall efficiency.
- Taught new adjusters how to monitor claim trends for potential fraud indicators, contributing to the reduction of fraudulent activity within the company.
- Maintained thorough knowledge of company policies and insurance regulations, ensuring proper claim handling procedures were followed.
- Helped new adjusters assure timely verification of insurance benefits.
- Helped new adjusters prepare insurance claim forms or related documents and reviewed for completeness.
- Provided guidance on how to accurately document a claim and attached information to claim files.
Arbitration Panelist
Arbitration Forums
09.2001 - 12.2019
- I was an Arbitrator on a 3-person panel and as an individual panelist.
- Analyzed evidence and contentions.
- Prepared written decisions regarding cases based on evidence and applicable laws.
Payment Recovery Specialist
TCRI/PIP Adjuster
09.2001 - 09.2007
- Collected all necessary documentation and data needed for reimbursements of PIP, Uninsured/Underinsured motorist and property damage payments. Handled all recovering payments. Calculating subrogation expenses. Negotiating settlements with other insurance companies of individuals at fault.
- Handled subrogation against uninsured parties and negotiated payment arrangements with customers, resulting in increased revenue and reduced delinquencies.
- Filed arbitration against participating members. Created contentions, responses, addressed decisions, and payments if applicable.
Claims Service Representative
GEICO
09.2000 - 09.2001
- Took first notice of loss, confirmed coverage, liability and damages. Set up Auto Damage assignments, rentals, handled basic claims investigations and liability decisions.
- Verified if any injuries (First party - PIP and third party - Bodily injury) and escalated files to appropriated department if applicable.
- Enhanced customer satisfaction by efficiently processing and resolving claims in a timely manner.
- Provided exceptional customer service by addressing concerns, answering questions, and explaining complex policy information to clients.
Education
Legal Principles Claims Specialist - Earned LPCS Designation
American Educational Institute
Lakeland, FL08.2004
Adjuster Property & Casualty (0644) - State of Florida License # D059769 - ACTIVE
State of Florida License
Lakeland, FL11-2000
General Lines Agent and All- Lines Adjuster - General Lines Agent And All- Lines Adjuster
Polk Community College
Lakeland, FL10.2000
High School Diploma -
Onaway High School
Onaway, MI05.1985
Skills
- Claims investigation, Decision-making, Claims negotiation/Settlement negotiation
- Damage assessment, Property valuation
- Policy interpretation
- Coverage determination
- Critical thinking, Active listening, Attention to detail
- Claims processing, Payment processing
- Medical Bill review and processing
- Analytical abilities
- Coverage assessments
- Customer service and support, Problem-solving
- Data entry
- Evidence reviews
- Coaching and mentoring
Timeline
Telephone Claims Service Representative and Personal Injury -PIP Coach
GEICO
05.2010 - 03.2023
TCRI/PIP Adjuster
GEICO
09.2007 - 04.2024
Payment Recovery Specialist
TCRI/PIP Adjuster
09.2001 - 09.2007
Arbitration Panelist
Arbitration Forums
09.2001 - 12.2019
Claims Service Representative
GEICO
09.2000 - 09.2001
Legal Principles Claims Specialist - Earned LPCS Designation
American Educational Institute
Adjuster Property & Casualty (0644) - State of Florida License # D059769 - ACTIVE
State of Florida License
General Lines Agent and All- Lines Adjuster - General Lines Agent And All- Lines Adjuster
Polk Community College
High School Diploma -
Onaway High School
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