Insurance Manager
Resume:
William Zela
Email: *********@********.***
Address: **** **** ****** *****
City: Katy
State: TX
Zip: 77449
Country: USA
Phone: 713-***-****
Skill Level: Experienced
Salary Range: 57
Willing to Relocate
Primary Skills/Experience:
See Resume
Educational Background:
See Resume
Job History / Details:
WILLIAM P. ZELA, LPCS
4307 Hawk Meadow
Katy, Texas 77449
QUALIFICATIONS PROFILE
Senior Claims Representative with extensive insurance experience in personal, commercial property and casualty claims specific to auto, commercial property, personal injury and general liability claims, slip and falls as well as food borne illnesses including litigation and risk management.
* L.P.C.S. Legal Principles Claims Specialist
* Superior analytical skills in claims investigations, evaluations,
negotiations and settlements.
* Experienced with SIU protocol having been a fraud liaison for detecting fraudulent and suspicious claims using industry databases, NICB indicators and other internet applications.
* Proven record for successfully analyzing and managing a high volume of claims within discretionary authority.
* Litigation experience with trial lawyers having attended depositions, hearings, trials from beginning to end, mediations and arbitrations.
* One (1) year of supervisory experience in commercial lines.
* Working knowledge of Spanish and auto mechanics.
PROFESSIONAL EXPERIENCE
Aon Global Risk Consulting
SENIOR CLAIMS CONSULTANT, May 2011 to August 2012
1.Provide oversight and monitor the third party administrator for auto liability
and general liability claims with the third party administrator.
1.Pursue Subrogation on claims, primarily auto physical damage and property
damage from third parties as well as general liability.
1.Manage third party pursuit of subrogation claims against the client for damage to
rental vehicles.
1.Input and reconcile data related to automobile liability and subrogation activities in the clients Riskmaster database.
1.Provide administrative support and investigate general liability claims.
1.Organize and attend claim review meetings at sites when needed.
1.Responsible for reporting of International claims.
1.Attend meetings at clients office when requested.
ACCC Insurance Company
Bodily injury adjuster, February 2010 to April 2011
Adjusted claims in an office environment and worked with support teams to reach claims resolution. Managing an inventory of between 300 to 320 files while assuming 20-25 new weekly assignments and maintaining superior service level objectives within guidelines.
* Have complete comprehension of arbitration, subrogation, mediation, personal bodily injury, litigation, and property damages.
* Proficient in the Claims Inquiry bodily injury evaluation and settlement program.
* Proficient with the CCC evaluation, actual cash value and diminished value claims process.
Total Petrochemicals USA, Inc., Houston, Texas
Risk Management Senior Claims Analyst, June 2008 to June 2009
Setting up of new claims and managing preexisting claims in an office environment. Inventory was over 900 files.
* Handling of litigation with the aid of defense counsel, in-house counsel, insurance carriers and third party administrators.
* Entered over 900 files into a new computer claims system and establish databases.
* Types of cases handled involved commercial auto liability, general liability, pollution liability, marine cargo and property damages.
* Sent quarterly requests to the insurance carriers and third party administrators seeking reimbursement for defense and indemnity costs through use of Excel.
* Attended mediation as a representative of the company when necessary.
GEICO Insurance Company, Houston, Texas
Claims Examiner II, May 2007 to May 2008
Adjusted claims in an office environment with 10 to 15 new weekly assignment. Managed an inventory of 130 files.
* Have complete comprehension of arbitration, subrogation, mediation, uninsured motorists, underinsured motorists, personal bodily injury, property damages, Personal Injury Protection and Medical Payment files.
* Proficient in the Claims Inquiry bodily injury evaluation and settlement program.
* Proficient with the Wrexpert Collision Program concerning the relationship of injuries due to automobile accidents.
State Farm Insurance Company, Houston, Texas
Senior Claims Representative, August 2001 to April 2007
Adjusted claims in a field office environment and worked with support teams to reach claims resolution. Managed an inventory of between 100 to 120 files while assuming 20-25 new weekly assignments and maintained superior service level objectives within regulatory guidelines.
* Have complete comprehension on subrogation and underwriting potential on each loss.
* Winner of State Farm Extra Effort Award/subrogation, October, 2006.
* Consistently recognized claim activities that met SIU criteria for proper referrals.
* Consistently recognized claims files for referral to our Spanish Language Team within the claims department.
Wausau Insurance Company, San Antonio, Texas
Senior Case Manager/(SUPERVISOR), March 2000 to July 2001
Adjusted claims in commercial claims field office environment with a heavy emphasis in the litigation area. Did extensive coverage analysis on files and handling high profile litigated cases. Managed an inventory of between 100 to 130 files. Promoted to supervisor with supervision over 3 commercial adjusters.
* Have complete comprehension over commercial claims process.
* Handled coverage issues on complex commercial files.
* Handled litigated files as well as the supervision of those files with defense counsel.
* Attended mediations and trials to conclusion.
* Supervision of claims representatives.
* Winner of Raving Fans Award for Customer Service.
Kemper Insurance Company, Houston, Texas
Senior Claims Specialist, March 1999 to March 2000
Adjusted personal and commercial claims, toxic tort claims, errors and omissions claims, product liability cases, slip-and-falls, professional liability claims as well as coverage analysis inclusive of disclaimers and reservations of rights letters. Managed an inventory of between 150 to 170 files.
* Handled litigated files and coverage issues on complex commercial claims.
* Handled several large profile accounts including Hollywood Theaters, IHOP, James Coney Island and the Texas Medical Center.
* Appointed to the Office Advisory Committee on how to handle customer complaints and provide superior service.
* Helped to establish the subrogation department.
* Winner of the Spot Award for exemplary and superior investigative work.
St. Paul Fire & Marine Insurance Company, Houston, Texas
Senior Claims Representative, October 1995 to February 1999
Adjusted personal and commercial claims, toxic tort claims, errors and omissions claims, product liability cases, dog bites, slip-and-falls, professional liability claims. Managed between 160 to 180 files.
* Handled litigated files and attended many depositions, mediations and trials to conclusion.
* Handled several large profile accounts including Texas Southern University, the PGA Tour, USA Track & Field and the Athletics Congress.
* Fraud liaison to SIU.
* Colossus consultant (computer settlement/resolution program).
* Employee of the month November 1997.
* Winner of Two (2) Fraud Claims Awards in February 1997 and January 1998.
Farmers Insurance Group, Houston, Texas
Senior Claims Representative, February 1989 to September 1995
Adjusted bodily injury claims, rental bills, estimates of damages vehicles, complete file investigations as well as handle special cases assigned to me by the manager or supervisor with work experience in subrogation and arbitration of files. Managed between 150 to 225 files.
* Perfect Attendance Award 1990.
* Presidents Regional Management Zone Contest Award - 1st Place.
* Outstanding Claims Representative Award, 1990.
* Employee of the month, March of 1990.
* Superior Service Claims Awards in 1991 and in 1993.
ASSOCIATIONS- LICENSING-EDUCATION
LPCS Legal Principles Claims Specialist 1998
Society of Claims Law Associates
Houston Claims Association
Independent Insurance Agents of Houston
TEXAS DEPARTMENT OF INSURANCE
Property Casualty Adjuster License #295108
FLORIDA DEPARTMENT OF INSURANCE
Property & Casualty Adjuster License #P20863
LOUISIANA DEPARTMENT OF INSURANCE
Automobile & Personal Lines Clams Adjuster License # 554807
Bachelor of Arts in Telecommunications
Minor in Health Education
Texas Tech University - Lubbock, Texas, 1988
Proficient PC Skills: Microsoft Windows XP, Word, Excel, PowerPoint, Outlook
OTHER SKILLS: Working knowledge of computers. Skilled typist@ 53 WPM. Very knowledgeable with ICD9, CPT coding, CMS 1500 and UB-92 medical claims analysis; highly experienced with in-depth phone and in-person interviews required in complex investigations; able to communicate with attorneys, account representatives, agents, witnesses, police officers and medical providers as needed in individual cases; familiar with HIPPA regulations as related in claims adjudication. Also worked as a Special Investigations Unit fraud liaison between liability and the fraud unit.
REFERENCES:
Christine S. Hughes, ARM, Claims Manager, TOTAL American Services, Inc. 713-***-****
Joe Loya, Vice President of Claims, Fairmont Specialty Insurance Company/ owned by Crum & Forester, 713-***-****, ext. 8737
Bill Pearce, Sr. Vice President, Aon Risk Solutions, Marine & Energy Claims 832-***-****
Steve Williams, Director of Risk Management, Nabors Corporate Services, Inc. 281-***-****
Lynne Jurek Shannon, Attorney At Law, Lugenbuhl, Wheaton, Peck, Rankin & Hubbard 713-***-****
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