Quality Assurance Liability Claims, Professional Liability claims
Resume:
Saundra “Sandy” Feller
**** ********* *****, **********, ** 95833
916-***-**** home 916-***-**** cell
ad5txc@r.postjobfree.com
SUMMARY OF PROFESSIONAL EXPERIENCE
Casualty claims adjusting (personal auto, commercial, homeowner liability and professional liability)
30 years, responsible from claim reporting to settlement, with personal authority up to $100,000, receiving settlement authority in excess of $1,000,000.
Settlement, claims handling and litigation support
Represented the company and assisted litigation at Mandatory Settlement Conferences (MSC).
Represented companies in over 60+ mediation conferences.
Successfully supported policy holders in small claims court over 50+ times.
Evaluating and resolving commercial general liability and automobile liability claims
• Analyzing coverage issues, creating disclaimers and reservation of rights
Recognizing, utilizing tender, risk transfer and subrogation opportunities
Applying above average knowledge of law toward claims settlement
Managing litigated files, directing counsel over resolution strategies within budget
Special Investigation – Fraud team - 3 years’ experience investigating suspect medical providers, attorneys and body shops.
Mentoring and training
As a senior adjuster 25% of my time was allotted to mentoring and training.
8 years as a fulltime trainer producing curriculum and providing training from entry level through senior adjusters.
Quality Assurance
4 years on quality assurance team reviewing adjuster claims files identifying areas for improvement followed by feedback, coaching and training as needed. This would be on an individual or group basis.
Performance analysis and executive presentations
Collected and analyzed data across different disciplines producing comprehensive reports presented several times a year.
Presented to regional VP twice a year.
WORK HISTORY:
Current: Home Care workers: Self Employed
NATIONWIDE INSURANCE May 2023
Claims Examiner III
nvestigate, evaluate, and resolve commercial lines claims of high severity and
complexity to a successful resolution. The specialist will handle litigation in this position
and is expected to navigate brokerage policies that require special handlin
nvestigate, evaluate, and resolve commercial lines claims of high severity and
complexity to a successful resolution. The specialist will handle litigation in this position
and is expected to navigate brokerage policies that require special handlin
Investigate, evaluate, and resolve commercial lines claims of high severity and complexity to a successful resolution. The specialist will handle litigation in this position and is expected to navigate brokerage policies that require special handling.
Resolves claims, of a complex and severe nature, in compliance with company quality standards. This may include such claims as arson, fraud, excess/umbrella, directors and officers, medical and legal malpractice, governmental liability, products and completed operations and premises bodily injury.
Maintains current knowledge of all insurance lines, court decisions which may impact the claim function, current guidelines in the claim function and policy changes and modifications. This may require attending various seminars and training sessions
ATHENS IINSURANCE TPA February 2016 to 2018 and July 2022
Claims Examiner II, now Senior examiner
Review, analysis and processing of complex commercial auto and trucking and general liability claims within assigned authority limits and consistent with policy and legal requirements.
Investigate, evaluate and determine settlement value or denial of liability for severe to major level claims. High exposure and often entail litigation and coverage issues
Manage the litigation process through the retention of counsel. Adhere to the line of business litigation guidelines to include budget, bill review and payment
Prepare comprehensive reports as required. Identify and communicate specific claim trends and account and/or policy issues to management.
Analyzes claims activity and prepares reports for clients/carriers and management
Analyze coverage
CUNA MUTUAL GROUP August 2019 to July 2021
Litigation Consultant II
Handled claims under the business protection policies to include: Bond claims, Employment Practices Liability claims, Lender Liability claims, Property and Business Liability claims and Business Auto claims.
Handled coverage and disclaimers on the majority of claim
Life Insurance Sales, Hart Group March 2019 to August 2019
BROADSPIRE; a CRAWFORD COMPANY August 2014 to 2015
TPA
Senior Examiner
Claims specialist with commercial auto and general liability
Makes decisions using independent judgment on complex and unusual policy cover ages
Handling litigated and non litigated claims
Analyzes claims activity and prepares reports for clients/carriers and management
NATIONWIDE INSURANCE: SACRAMENTO CA October 2005 - August 2014
Field Claims Specialist March 2013 - August 2014
Responsible for claims, including negotiations and settlements.
Attended numerous small claims court trials, mediations, and settlement conferences on behalf of the company.
Completed large loss reports and attended claims conferences, receiving settlement authority in excess of $500,000.
Claims Training and Quality Assurance Specialist October 2009-March 2013
As a direct report to the Director of Claims:
Conducted, planned and developed technical and soft skill training throughout the entire company.
In support of Regional Director, reviewed work of all regional associates and generated monthly reports and performance improvement recommendations based on the reviews.
Senior Trainer and Developer in the Learning & Performance Department March 2006 – October 2009
Planned, designed, developed, and implemented six week new-hire comprehensive training curriculum covering claims handling technical skills and customer service (soft skills).
Provided new business process and system training. Tasked to learn new concepts and procedures with the objective of delivering formal training to the rest of the company.
Provided formal and informal classroom training and coordinated professional speaker series.
Casualty Master Claims Representative October 2005 - March 2006
Investigated, evaluated, and negotiated personal lines injury/casualty claims and commercial lines, casualty claims, and farm casualty claims. Handled large loss claims.
Handled and investigated injury claims Negotiated and settled claims with attorneys.
ESURANCE: ROCKLIN, CA
Large Loss Bodily Injury (BI) Claims Specialist February 2005 - October 2005
Handled and investigated injury claims negotiated and settled claims with attorneys.
CALIFORNIA STATE AUTOMOBILE ASSOCIATION February 1990-January 2005
Field Liability Generalist April 1996 - January 2005
Investigated, evaluated and settled numerous auto and homeowner Bodily Injury claims.
Conducted vehicle inspections and settled property damage claims.
Interviewed all parties involved in the claim.
Prepare files for Small Claims Court and litigation.
Attend mediations, arbitrations and trials.
Oversaw claims through litigation, mediation, arbitration and settlement conferences.
Attended hearings while on the inter-company arbitration board.
Special Investigations Claims Specialist May 1993- March 1996
Investigated suspected fraudulent claims to determine fraud.
Developed fraud case to present to the Fraud Division of the DOI.
PROFESSIONAL SKILLS
Microsoft Office, Outlook and Lotus Notes.
Adept at web research for claims investigations.
Claims operating systems.
Skilled at developing an excellent rapport with all levels of clientele and staff.
Superior customer service skills
EDUCATION
BA, Sonoma State University: Sociology with a minor in Liberal Arts
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