TreMonisha Falligan

• Highest level individual contributor position reviewing claims of high complexity to determine nature of loss, coverage, and th scope of the claim.
• Completes timely evaluation, reserving and disposition of assigned claims.
• Documents coverage, investigation, damages, reserve rationale, negotiations.
• Investigates potentially fraudulent claims and make referrals when required.
• Completes recommendations for settlement/disposition of claims.
• Identifying opportunities for contribution, subrogation.
• Prepares required reports for senior management
• Handles a diverse mix of high-exposure complex claims, and catastrophic losses including but not limited to, professional liability, ADA, sexual harassment, Class Action suits, personal and advertising injury, and employers liability, directors and officers, product, errors and omissions, property damage.
• Proficient in New York Labor Law claims and construction defects.
• Handles both primary and Excess files.
• Handles and resolves claims with reserves of 10 million or above.
• Makes recommendation to obtain an independent adjuster to complete field investigations.
• Works closely with underwriting to evaluate the risk.
• Conducted full claim investigations and reported updates and legal actions.
• Negotiated with other involved parties to arrange settlements for maximum results.
• Drafted and reviewed legal documents utilizing knowledge of relevant clauses to minimize incurred liability.
• Collaborated with legal counsel to make organizational claims decisions aligning with governing laws.

• Employed problem solving skills and critical thinking to handle escalated issues and mitigate risk.
• Responsible for management of daily workloads task delegation and workflow prioritization ensuring effective functioning for the department.
• Partner with TPA leadership and claims teams to ensure prompt resolution of claims re-channeled from prior carriers.
• Conducted claim reviews, developed and implemented investigation closure strategies, establish and maintain a positive work environment and culture.
• Encourage staff performance and developing sensitives to reward positive progress.
• Conducted regular employee performance evaluations regarding process and compliance to offer constructive feedback, and identified areas for additional coaching and offering solutions to areas of concern in order to drive improvements in growth insurance accuracy of claims documentation and compliance with federal state and local laws.
• Maintain effective and accurate handling of materials., files and documentation in order to expedite claims process and maximize downtime.
• Drove account financials through team utilization optimal staffing levels and secured adherence.
• Assisted customers with completing claims requests by facilitating prompt responses from carriers and following up on claim status in short positive customer interaction throughout the process.
• Oversaw internal staff and external third party administrators handling injury exposures of moderate to complex severity including litigated matters directly responsible for settlement and resolve approvals within 750K to 1,000,000 in authority.
• Oversee reserving tier claims and access layers provided staff with strategic direction and claims Technical Support.
• Ensure staff is performing within the departmental guidelines through routine claims audits provided one-on-one personal coaching and group coaching and development sessions.
• Work with access carriers regarding reported losses and claims above self insured retention, oversee and manage relationships with regional law firms actively participating in complex litigation strategy discussions.

• Independently managed Architecture & Engineering claims in compliance with established company policies, procedures, and appropriate legal and regulatory framework.
• Maintained consistent professional rapport with senior claims management to ensure timely communication of key claims and issues.
• Acted as liaison for policyholders, underwriters, and brokers daily.
• Collaborated with policyholders and defense counsel to develop and implement best strategies for favorable claims resolution.
• Attended mediations and settlement conferences.

• Managed a high-level mixed inventory of complex general liability litigated claims including but not limited to complex, large, and catastrophic losses, professional liability, ADA, sexual harassment, Class Action suits, personal and advertising injury, and employers liability, directors and officers, product, errors and omissions, property damage.
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• Analyzed coverage in order to identify any issues; drafted coverage letters and correspondence.
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• Attended trial, mediations, mandatory settlement conferences, and alternative dispute resolutions.
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• Coordinated and led coverage review analysis with team to minimize need for external coverage opinions.
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• Recommended actionable analytical insights to drive claims results.
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• Maintained up-to-date appropriate documentation, written file notes.
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• Proactively participated on Executive Team to establish and execute the strategic direction of the company.
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• Ensured the continual professional development of personnel by coordinating internal and external training opportunities.

• Supervised all claims operations for designated claims specialists, ensuring adherence to corporate claim standards and compliance.
• Conducted comprehensive reviews of claims files to assess conformity with company practices, protocols, and service levels. Identified any deficiencies and recommended action plans for improvement.
• Collaborated with the Executive Team to discuss, evaluate, and implement strategic directions for the claims operation, aligning with the company's mission.
• Managed a growing team of claims professionals by establishing clear performance metrics and effectively communicating them.
• Developed and implemented policies and procedures to foster coordination within the team and drive progress towards shared goals.
• Coordinated with the underwriting department to review current and proposed policy language and explore potential new market opportunities.
• Progressed from Senior Claims Specialist III (Litigation) to leading a remote team operating across multiple geographic locations. Managed the claims handling process related to public liability and property damage.
• Oversaw internal staff and external third-party administrators handling moderate to complex severity injury exposures, including litigated matters.
• Conducted routine claim audits to ensure adherence to departmental guidelines.
• Provided personalized one-on-one and group coaching sessions to support professional development.
• Collaborated with excess carriers on reported losses and claims exceeding self-insured retention.
• Maintained relationships with regional law firms and actively participated in complex litigation strategy discussions.
• Developed and implemented operational procedures to enhance efficiency, reduce cycle times, and control costs. Monitored loss trends and recommended risk mitigation opportunities.
• Cultivated and maintained business relationships with internal departments.
• Moderated quarterly reviews with external partners to discuss key performance indicators.
• Maintained a strong understanding of tort law, the legal system, and contracts.
• Participated in multiple restructuring phases, including conducting interviews, realigning staff reporting, and providing coverage analysis.
• Performed comprehensive data analysis to draw conclusions on risk behaviors.
• Created action plans to mitigate identified risk behaviors and ensured effective communication to stakeholders and team members.
• Implemented an enterprise risk management model, enabling claims to be handled by third-party administrators (TPA) instead of in-house risk staff.

• Managed high-level general liability litigated claims. Assigned counsel and coordinating with counsel on establishing litigation plans and budgets.
• Consistent monitoring of claims for potential resolution.
• Exercised independent discretion in handling complex and high-exposure commercial liability claims.
• Evaluated and made recommendations regarding claims coverage.

• Held multiple roles during 8-year tenure: Medical Representative, Senior Litigated Medical Representative, Litigation Department Supervisor, and Senior Casualty Representative.
• Recognized for exceptional claims handling.
• Evaluated complex high-level bodily injury claims and worked to resolve them in compliance with company guidelines and policy limits.
• Trained all incoming new hires to assist with acclimation to role.
• Prepared files for trial, mediation, and arbitration; attended as needed.

• Maintained "open door" policy to encourage employee communications and resolution of issues.
• Directed each phase of hiring process, encompassing employment verification, employee relations investigations, criminal background checks and onboarding.
• Maintained human resources regulatory compliance with local, state and federal laws.
• Coordinated and worked with management on performance evaluations, supervisory practices, dispute resolution, and employee accountability.
• Structured compensation and benefits according to market conditions and budget demands.
• Collaborated on hiring and training of new employees, professional growth of staff and team building and motivation.
• Maintained optimal staffing levels by tracking vacancies and initiating recruitment and interview processes to identify qualified candidates.
• Developed succession plans and promotion paths for staff.
• Participated at strategic and operational level to develop and strengthen human resources services, relationships and mission.
• Educated employees on company policy and kept employee handbook current.
• Interviewed potential hires, negotiated salaries and benefits and performed reference checks.
• Directed hiring and onboarding programs for new employees.
• Fostered cross-functional relationships to connect managers and employees and improve overall efficiency.
• Provided updates on HR policy changes to employees to satisfy compliance and state laws.
• Developed company budget and monitored expenditures
• Analyzed gross profit factors market and business volume as well as operational costs and requirements.
• Ensured continued growth of the branch by engaging with new clients and focused on customer retention of existing client base.
• Worked with recruiters to recruit and hire new employees.
• Managed onboarding process for new hires including orientation and establishing employee insurance and benefits.
• Responsible for payroll, accounts receivable, accounts payable, and bookkeeping; maintained all company and employee insurances.
• Scheduled personnel according to workflow requirements and individual availability; monitored schedules on a daily basis.
• Responsible for underwriting company policies and procedures manuals in accordance with company guidelines and state regulations.
• Oversaw employee reviews and disciplinarian reviews.
• Member of Board of Directors.

Newcombe Scholarship Recipient.