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Click here or scroll down to respond to this candidateCandidate's Name
Address -Greenbelt MDPHONE-PHONE NUMBER AVAILABLEEMAIL AVAILABLESummary: Excellent professional with experience in processing collected payments, negotiating payments and filing arbitration on disputed cases. Experienced in inspecting and writing damage appraisals. Experience in personal auto, boats and medical insurance In-depth knowledge of Property Damage insurance and medical terminology Organized and efficient in all work Ability to meet deadlines and follow up in a timely manner. Great ability to gather information and input data into computer system Provide customer service, such as explaining the requirements for filing a claim, limitedTECHNICAL SKILLS: Microsoft Word, Microsoft Excel, Microsoft Teams, Hyperion, Nitro Pro and SAP ERP,Microsoft Access,Microsoft Dynamics 365,WCIS,Comphub etcSkills: Exceptional communication skills with customers and coworkers Ability to grasp and apply technical knowledge, including litigation case management and adjusting skills. Effective reasoning, analysis and decision making skills. Effective influence skills. Strong negotiation skills. Strong organization skills. Strong hospitality skills. Demonstrate strong leadership abilities. Ability to prioritize work.Education:Bachelors Degree Economics, University of Ghana, 2002Worker Comp Claim AdjusterChessapeake Insurance Company, TowsonJuly, 2023 - Present Managed a caseload of worker compensation claims, including investigation, evaluation, and resolution. Worked closely with medical professionals, legal counsel, and other stakeholders to facilitate claim resolution. Conducted thorough interviews and investigations to determine compensability and identify potential fraud. Prepared and presented claim files for mediation, arbitration, and litigation as necessary. Provided exceptional customer service and maintained positive relationships with policyholders and claimants. Investigating claims independently to determine the validity and extent of the claim. Evaluating the claim based on the evidence gathered during the investigation. Negotiating settlements with claimants or their representatives. Settling claims in accordance with Maryland Workers Compensation Law and internal guidelines. Adjusting claims to ensure that they are handled fairly and efficientlyExelon (SGS Consulting) Contractor April 2019- June 2023Claims Coordinator Responsibilities: Coordinate the billing and collection for cases involving damage to Company property. Identify and obtain information and documentation essential for case disposition, participate in settlement negotiations, establish, and monitor extended payment arrangements, prepare, and distribute relatedcorrespondence and monitor case status. Provide general office and secretarial support to the Claims groups including typing, transcription, file maintenance, handling inquiries and other office support functions. Interface with other departments in Exelon including Audit Services and corporate accounting. Provide support to ADR programs, EEO support training, and Special Emphasis Programs. Schedule meetings, work on different virtual platforms, filing, typing, copying, and scanning. Identify the need for planning, organizing/filing, tracking/recording data and conducting analytical studies based on examination of the program needs. Represent program at meetings as member of working groups to complete program tasks. Prepare reports, presentations, report analysis, and summaries for the Lead and other staff. Provide a high-level administrative support to include conducting research, preparing statistical reports, handling information requests, and performing Administrative Assistant functions. Enter data into the Risk master and accounting software system to perform basic accounting functions. Process customer checks that is received and mailing out to remittance Manage litigation cases including controlling/directing outside attorneys, assisting in discovery/trial preparation and strategy. Evaluate claims for potential third party or subrogation recovery. Participate in the Service Call Program and complete required Service Call reports detailing current case status.Experience:Agency Insurance Company (Apex Systems), Hanover, MDOctober 20 18 AprilClaims RepresentativeResponsibilities: Investigated, determined liability, confirmed coverage, established damages, and negotiated settlement of claims. Received and reviewed appraisal assignments, reviewed and interpreted coverage, determined liability, identified exposures, contacted all parties involved, and set up inspection appointment. Sent PIP application forms to insureds and attorneys and review medical bills. Evaluated BI and negotiated appropriately, ratings, and conditions of vehicles to determine if a vehicle is repairable or a total loss. Submitted evaluation details to obtain a total loss value. Obtained salvage quotes, settled total loss claims. Processed collected payments, negotiated payments and filed arbitration on disputed cases. Effectively generated a large volume of complex letters. Maintained high volume of paper files, hired vendors and attorneys to manage cases and suits. Subjugated insurance companies, third parties, and uninsured for payment. Reviewed and analyzed suspicious and potentially fraudulent insurance claim. Compared data from surveillance footage on medical data. Soft tissue to severe auto bodily injury claims, mediation, global settlement and attending court trials with attorneys. Handles 1st party property claims of moderate severity and complexity as assigned. Completes field inspection of losses including accurate scope of damages, photographs, written estimates and/or computer assisted estimates. Broad scale use of innovative technologies. Investigates and evaluates all relevant facts to determine coverage, damages and liability of first-party property damage claims (including but not limited to analyzing leases, contracts, by-laws and other relevant documents which may have an impact), damages, business interruption calculations and liability of first party property claims under a variety of policies. Secures recorded or written statements as appropriate. Establishes timely and accurate claim and expense reserves. Determines appropriate settlement amount based on independent judgment, computer assisted building and/or contents estimate, estimation of actual cash value and replacement value, contractor estimate validation, appraisals, application of applicable limits and deductibles and work product of Independent Adjusters. Negotiates with multiple constituents, i.e.; contractors or insureds representatives and conveys claim settlements within authority limits. Writes denial letters, Reservation of Rights and other complex correspondence. Properly assesses extent of damages and manages damages through proper usage of cost evaluation tools. Meets all quality standards and expectations in accordance with the Knowledge Guides. Maintains diary system, capturing all required data and documents claim file activities in accordance with established procedures. Manages file inventory to ensure timely resolution of cases. |
