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Claim Adjuster

Houston, Texas, United States
November 28, 2018

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***** *** **** ***

Houston, TX *7083

Phone# 832-***-****

OBJECTIVE: Seeking a rewarding career in Insurance Claim Adjusting. EDUCATION & CERTIFICATE: 4yrs BA in Business Management at Oklahoma State University. Adjuster License 17-02 for several states (CA, TX, MO, LA). Numerous awards and training certificates for BI/PD/PIP/LIAB/Homeowner claims handling, Claim Portal, Integriclaims, Mitchel Int.,Simsols. CPCU classes, HSE, OHSAS Certificates for Insurance Examination: INS 21 and AIC 33.


2/2018 - 6/2018 QuestPro contract for AAA

Job Title: BI/Casualty Claim Adjuster

• Verifying that coverage exist

• Investigating and gathering information about claims by contacting all parties involved

• Documenting all decisions, correspondences, reports and discussions

• Gaining experience in determining liability and setting reserves

• Evaluating triage, medical bills, records, report for injuries' exposure about the claims

• Learning about determining if subrogation exists and taking steps necessary for recovery

• Resolving claims in the best interest of the insured, claimant according to company guidelines

10/2017 - 1/2018 TeleTech contract for FEMA

Job Title: Bilingual Customer Service Supervisor

• Oversee and monitor Service Rep to support the hurricane response and recovery efforts at the Call Center.

• Deliver prompt and effective Federal Assistant using FEMA Protocol

• Educate and assist hurricane victims for registration, emergency response, navigation and mitigation support, extend emergency lodging assistant

• Consult, train and motivate Service Rep to carry out productive and effective performance, resolve insurance issues

• Coordinate various level of communication and referral services such the Red Cross, SBA loan programs, local assistant for food and shelter.

• Establish and implement procedures to provide guidance and information, also update any correspondence and requests

7/2014 – 7/2015 Best IRS/State Farm Insurance Company Job Title: Pip/Medpay Sr. Adjuster

• Investigates, evaluates and adjusts moderately complex PIP/Medpay claims.

• Make timely contacts with insured, claimants and attorneys.

• Verifies coverage eligibility for all injured parties seeking PIP benefits.

• Reviews all pertinent medical reports to ensure that treatment billed is reasonable, related and medically necessary.

• Respond to all correspondence and pay medical bills in a timely manner.

• Works under limited supervision to perform work assignments, problem solving and claims resolution.

• Pursue subrogation/recovery opportunities, as warranted.. 5/2012 - 4/2014 Taking different assignment as Independent Adjuster (FEMA) called upon for catastrophe duty. For Catastrophe (CAT) roles, investigative fieldwork includes a high amount of travel to claim location. Negotiate and settle claims. 6/2006 -3/2012 Hartford Insurance

Job Title: BI Claim Adjuster

• Uses knowledge, experience, and independent judgment to determine liability and confirm coverage.

• Audits and verifies claimant and/or insured medical bills, expense bills, wage forms or other items presented for payment consideration or evaluation.

• Corresponds with agents, insured's, lien holders, attorneys, law enforcement officials, and internal departments to resolve claims.

7/2001 - 5/2006 Safeco Insurance Company

Job Title: Casualty Claim Adjuster

• Investigate claims: take recorded statements, obtain photos and/or conduct on scene investigations, review medical reports, document claim files and prepare triage summaries

• Determine liability, determine damages and negotiate a claim settlement in accordance with business unit best claim practices and authority

• Support litigation, arbitration or mediation requiring coordination with legal counsel

• Participate in depositions, hearings, trial or arbitration

• Deliver compassionate service, update correspondences

• Research and respond to internal/external communications 2/1989 - 3/2001 Unitrin Specialty Lines Insurance Company Job Title: Liability Claim Adjuster

Investigates and adjusts claims in accordance with established claims handling procedures

• Communicates with clients, witnesses, and claimants in order to gather information regarding claims and advise as to proper course of action. Responds to various written and telephone inquiries including status reports.

• Determines liability based upon investigation results and applicable state tort law .

• Identifies potential suspicious claims and identifies opportunities for third party subrogation.

PERSONAL: I am organized, detail and service oriented, focus, resourceful, multi-tasks, with analytical, persuasive and effective negotiation skills, self-motivated, team players, reliable and multilingual in English, French, Chinese and Vietnamese. Effective negotiation skills. strong written and oral communication skills; interpersonal skills; computer skills with the ability to work with multi-faceted systems; and analytical skills. Knowledgeable of laws and regulations as it applies to auto insurance industry within their state.

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