Claims Adjuster Processing

Edward Brown

Anniston, AL *****

256-***-**** - *****************@*****.***

Professional Summary

Insurance Adjuster skilled in investigating and analyzing liability concerning personal, casualty or property loss. Proven history of leveraging excellent negotiation skills to facilitate settlements. Excellent communication skills demonstrated through 4 years of experience interviewing specialists, witnesses and claimants to compile information.

Skills

Critical Analysis

Data Analysis

Caseload Management

Interpersonal Skills

Claims Investigation

Problem Solving

Legal Compliance

Insurance Regulations

Medical Terminology

High level claims processing

Insurance Policy Coverage Knowledge

Casualty and Property Loss

Legal Proceedings Knowledge

Claims Processing

Familiar With Fraud Statutes

Policy Investigations

CCC Reports

Best Practices Implementation

Regulatory Compliance

Coverage Assessments

Quality Control

Medical Coding

Advanced Computer Skills

Advanced Oral and Written Communication Skills

Work History

08/2023 to Current

MEDICAL/PIP/MEDPAY CLAIMS ADJUSTER

KEMPER INSURANCE – Birmingham, AL

Identify and analyze medical and expense claims for coverage eligibility

Establish accurate loss and reserve for damages

Research injury-related statutory provisions and case law

Obtain necessary documentation and conduct detailed research for claims

Utilize IME and Peer Review processes when appropriate

Reduce company costs by identifying fraud and misrepresentation attempts from attorneys and medical providers

Thoroughly document injury-related treatment and expense history, detail insite into billing and procedure breakdowns

Managed a caseload of 80+ claims per month, improving claim resolution times

Negotiated favorable settlements to minimize financial risk for the company

Conducted thorough investigations of complex insurance claims

Collaborated with SIU and legal teams to defend against fraudulent claims, saving company resources

Maintained compliance with state regulatory requirements through meticulous documentation

08/2020 to 08/2023

COMMERCIAL CLAIMS ADJUSTER

KEMPER INSURANCE

Maximized profitability by developing standards for determining complex coverage situations and liabilities in commercial auto claims

Saved company resources by processing attorney demands in a timely manner, reviewing authority reports, and managing all relevant documents

Conducted negotiations with various parties including attorneys, subrogation adjusters, and early BI settlements

Handled claims, investigations, policy reviews, valuation, and managed exposures, large pending volumes, and property damage

Exceeded goals with a 10-day closing cycle based on claim volume (100+ monthly) and percentages

Coordinated efforts between all parties involved in claims processing

Contributed to the integrity of the business by following state and federal guidelines for claim processing

Handled multi-jurisdictional claims and conducted objective reviews of claims, policies, and contract assessments

02/2016 to 03/2020

FIELD SERVICE MANAGER

Dish Network/MCK

Minimized liability cost by investigating damage claims onsite by documenting that the install is up to code, taking pictures of alleged damage, taking witness statements, and sending findings into headquarters with a denial/acceptance decision

Created strong company reputation with excellent customer service and interactions with customer at their residence and over the phone

Expanded the company's qualified work staff by supervising 12-20 technicians, developing, hiring, and training, set up expectations, accountability standards, onsite inspections of work, sales, and safety

Review balance sheets and income statements

Administrate using company software.

05/2013 to 02/2016

SATELLITE TECHNICIAN

Dish Network/MCK

Installed Dish Network television systems into customer's residence, provided exemplary customer service, upselling of products.

Education

12/2002

Associate in Art and Science Business and Accounting

PIERCE COMMUNITY COLLEGE - Fort Steilacoom, WA

Dean's List [Fall, Winter Spring 2001]

Certifications

Adjuster License for the following states CT, LA, DE, KY, NM, OK, RI, SC, NC, TX, VT, WY

FL Home state All Lines License

Websites, Portfolios, Profiles

https://www.linkedin.com/in/edward-brown-49304822a?lipi=urn%3Ali%3Apage%3Ad_flagship3_profile_view_b

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