Winter Daniels
Risk & Compliance Specialist
Austell,GA
Summary
Results-oriented insurance professional with expertise in investigative analysis and conflict resolution. Proven ability to achieve compliance while enhancing customer satisfaction. Skilled in navigating complex regulations and promoting teamwork to deliver fair settlements and effective solutions.
Overview
13
13
years of professional experience
Work History
Customer Resolution Specialist- Auto
State Farm
Atlanta, GA
05.2024 - Current
- Investigates escalated auto claim inquiries through a comprehensive review of claim files and regulations.
- Analyzes claim data and complaint trends to identify compliance risks and recommends corrective actions.
- Coordinates with the claims department to ensure effective resolution of customer issues.
- Exceeds productivity, quality, and timeliness benchmarks while managing complex auto claim issues.
- Prepares detailed written and verbal responses addressing coverage determinations, liability decisions, settlement outcomes, and claim-handling processes for the Department of Insurance.
Claim Specialist- Weather & Catastrophe Claims Services
State Farm
Atlanta, GA
02.2020 - 05.2024
- Managed inventory of over 70 property claims with efficiency and effectiveness.
- Conducted thorough investigations to verify coverage, determine liability, and evaluate damages for fair settlements.
- Performed virtual property inspections, prepared estimates, and negotiated claim settlements within authority limits.
- Communicated claim decisions to policyholders, claimants, and third parties, clarifying policy provisions.
- Reconciled contractor repair estimates, identified discrepancies, and collaborated to ensure compliance and accuracy.
Human Resources Associate (Contract)
Vaco
Atlanta, GA
12.2019 - 02.2020
- Managed employee records, ensuring compliance with federal and state laws, maintaining accuracy and confidentiality.
- Facilitated communication between management and staff concerning HR policies.
- Addressed employee inquiries regarding benefits packages, vacation policies, and payroll issues efficiently.
- Safeguarded sensitive human resource information, preserving employee confidence and protecting operations.
- Resolved high-volume inbound inquiries and complex issues in Workday, adhering to compliance standards.
Claims Investigator
Criminal Justice Coordinating Council
Atlanta, GA
04.2016 - 04.2019
- Conducted thorough investigations of compensation claims by gathering evidence and analyzing documentation.
- Authorized and processed over $1.64 million in claim payments, ensuring compliance with Georgia law.
- Reviewed appeals while coordinating with law enforcement and legal partners to minimize overpayments.
- Analyzed documents and reports to detect inconsistencies or fraudulent activities.
- Facilitated communication among various agencies involved in criminal justice matters.
- Presented findings and conclusions through both verbal and written reports for legal review.
Claims Specialist (Hail Reconciliation Unit)
State Farm
Atlanta, GA
04.2013 - 03.2016
- Investigated and reconciled over 50 hail damage claims for equitable settlements.
- Reviewed estimates, photos, and repair documentation to ensure compliance with guidelines.
- Expedited claim settlements to improve experiences for agency partners and customers.
- Applied knowledge of state and federal laws to navigate insurance regulations effectively.
Education
B.A. - Criminal Justice
Clark Atlanta University
Atlanta, GASkills
- Customer focus
- Adaptability
- Investigative analysis
- Conflict resolution and negotiation
- Critical thinking and problem solving
- Teamwork and relationship building
- Policy interpretation and compliance
- Claim management and evaluation
Accomplishments
- Received a Remarkable Award.
- Received Good Act Award.
- Consistently meets and exceeds the service level objectives.
- Processed over 3,825 claim queue items, over twice as many as prior year.
- Administered over $1.64 million dollars in claims.
- Acknowledged for account reconciliation to reduce overpayment in claims.
Timeline
Customer Resolution Specialist- Auto
State Farm
05.2024 - Current
Claim Specialist- Weather & Catastrophe Claims Services
State Farm
02.2020 - 05.2024
Human Resources Associate (Contract)
Vaco
12.2019 - 02.2020
Claims Investigator
Criminal Justice Coordinating Council
04.2016 - 04.2019
Claims Specialist (Hail Reconciliation Unit)
State Farm
04.2013 - 03.2016
B.A. - Criminal Justice
Clark Atlanta University