Claims Examiner Representative
Resume:
GAY “LESHUN” WHITE
**** ****** ****** ****, **********, FL 33823 Cell 863-***-**** Email: adwagq@r.postjobfree.com
OBJECTIVE
Motivated Claims Examiner/Adjuster with over fifteen years of experience specializing in personal property and casualty loss, damages, and injuries. Negotiates peaceful resolutions of all claims with an emphasis on fairness and thoroughness. Examine claims data, investigate the facts of loss, determine coverage and liability, and adjusts claims within limit of authority
SKILLS & ABILITIES:
Proficient in Microsoft Office (Word, Excel, Outlook, PowerPoint)
Obtain/Maintain appropriate licensing or educational requirements
Demonstrate proficiency in file audits to agreed standard of efficient claims quality
High degree of initiative, mature judgment, and discretion
Ability to resolve conflicts and empathize with customers
Strong negotiation skills
Demonstrate professional oral and written communication skills
Organization and time management skills
Demonstrate an understanding of insurance law as it relates to claims
Quick Learner
EXPERIENCE
Pre-Suit Paralegal/Todd Miner Law
09/2021-Present
Contact clients to discuss their potential cases
Make sure there is coverage
Monitor client’s treatment, to make sure there is enough coverage and determine if treatment is consistent with injuries
Keep in contact with client on a monthly basis
Gather all medical records and prepare demands
Negotiate with insurance companies for amicable settlement of claims
Do monthly reports
MATERIAL DAMAGE SENIOR CLAIMS REPRESENTATIVE/DIRECT GENERAL
4/2018-4/2021
Receive claim assignments and verify/investigate coverage and document all appropriate information before Manager is involved with review of claims to ensure they are commensurate with ability
Establish an investigative plan; initiate investigation by gathering facts and evidence with all interested parties; complete appropriate reports; take recorded statements, when necessary, may review loss reserves and adjust or opens hidden exposures as necessary
Evaluate and adjust claims within limit of authority and summarize claims in excess of authority and submit to manager for approval
Evaluate settlement alternatives by reviewing regulatory compliance and fair claims practices; make decisions on best option
Make appropriate contacts to discuss a settlement; extend an offer to appropriate party; document all file activity and payment/settlement information in file notes clearly outlining basis for settlement
Determine subrogation or fraud potential and refer to Unit when potential exists or handle to conclusion
May handle more complex files with appropriate supervision to develop skills
Develop a working knowledge of systems and technology used within the company
Identify customer needs and work to meet those needs using appropriate customer service skills
CLAIMS EXAMINER/WRIGHT FLOOD
10/2017-3/2018
ACCOUNTABILITIES/JOB DUTIES:
• Examine and evaluate claims investigated by field adjusters
• Adjust reserves to provide reserves recommendations to ensure that reserve activity are consistent with the NFIP program requirements.
• Review adjuster reports to ensure that claim file has sufficient documentation to justify all coverage and damage decisions.
• Pay and process claims with within designated authority levels.
• Handle claims toward resolution in a timely manner.
• Interact with policyholders, field adjusters and experts to resolve coverage issues.
• Respond to all incoming correspondence on assigned files including denial letters.
• Determine whether additional expert(s) are required to assist field adjuster in properly resolving the claim.
• Identify subrogation and salvage recovery opportunities and initiate prompt recovery.
• Comply with all FEMA and the NFIP rules and regulations.
• Prepare waiver of the proof of loss where necessary.
• Work in the document workflow system ImageRight and Hobbes
PROPERTY DAMAGE/BODILY INJURY ADJUSTER/STATE FARM INSURANCE THRU BANKERS FINANCIAL (BINTECH) AS An INDEPENDENT ADJUSTER
3/2017-9/2017
Establish an investigative plan; initiate investigation by gathering facts and evidence with all interested parties; complete appropriate reports; take recorded statements, when necessary, may review loss reserves and adjust or opens hidden exposures as necessary
Evaluate and adjust claims within limit of authority and summarize claims in excess of authority and submit to manager for approval
Evaluate settlement alternatives by reviewing regulatory compliance and fair claims practices; make decisions on best option
Make appropriate contacts to discuss a settlement; extend an offer to appropriate party; document all file activity and payment/settlement information in file notes clearly outlining basis for settlement
Determine subrogation or fraud potential and refer to Unit when potential exists or handle to conclusion
Identify customer needs and work to meet those needs using appropriate customer service skills
INDEPENDENT SALES AGENT, AFLAC
10/2013-02/2014
Knowledge of health insurance, Affordable Health Care Act, cold calling, prospecting, and
meeting with potential clients face to face, researching businesses, business to business sales
CERTIFIED HOME HEALTH AIDE/HELPING HAND NURSING SERVICES
6/2014-2/2017
Helping the elderly with daily living activities, medication
BODILY INJURY/UM CLAIMS EXAMINER/GEICO
10/1999-08/2013
Receive claim assignments and verify/investigate coverage and document all appropriate information with very limited Supervisory involvement
Work with attorneys in resolving serious and complex lawsuits which may mean: conduct negotiations
Demonstrate the capability of consistently handling aggregate file exposures of at least $25,000
Has thorough knowledge of claims policies and procedures in resolving claims and/or providing technical direction to claims representatives
Demonstrate the ability to interpret and apply written coverage accurately to establish claim and determine action plan, and rarely requires assistance on complex claims
Investigated potential fraud claims and worked with SIU and Field Representatives to coordinate plan of action
Saved Company money by recognizing/proving fraudulent claims
EDUCATION
University of Florida
Gainesville, Florida
Anthropology-AS Degree
CERTIFICATIONS/LICENSE
Insurance Adjuster License
COMMUNICATION
Team Player
Church Clerk-in charge of church announcements, handle church calendar for all church events and send out church updates and important information
LEADERSHIP
On the finance committee at my church; help make financial decisions, make sure bills are paid on time every month, keep track of church expenses
REFERENCES
Melissa Jones
Co-Worker
Tresa Green
CU Manager/GEICO Insurance
Karen Getz
Former Co-worker
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