Human Resources Claims Representative

CANDICE GAINES

*******.*****@*****.*** 205-***-****

EXPERIENCE

Insurance Claims Representative

P&S Logistics, LLC – Birmingham, AL February 2021 to January 2024

Managed, investigated, and resolved claims ensuring that claims were not fraudulent

Communicated with policy holders, witnesses and claimants to gather information regarding claims

Referred tasks to auxiliary resources as necessary advising of proper course of action

Created reports detailing the events and damages related to the claim

Negotiated settlements and authorized payments after completion of thorough investigation

Financial Support Worker

Department of Human Resources – Birmingham, AL March 2018 to February 2021

Interviewed clients, determined eligibility and made decisions on cases in compliance with state and federal laws and regulations

Established and maintained effective communication with department heads, the public, and internal employees to ensure that information was provided in a timely manner

Managed over 900 active Montgomery County Food Stamp cases

Served as a lead on my team, training new hires, mentoring, providing performance feedback, and assigning job responsibilities

Served on the Mentoring Group Committee to encourage peers on how to demonstrate effective work habits and practices

Property Damage Adjuster

ACCC Insurance Company – Hoover, AL July 2015 to March 2018

Performed detailed day one investigations, including securing recorded statements and obtaining contractual documentation

Demonstrated professional communication by paying attention to details, listening, documenting and providing information to all parties, ensuring their understanding of the next steps in the claims process

Provided facilitation, collaboration, negotiation, and conflict resolution while assisting with evaluating, analyzing, and interpreting insurance processes

Exceeded recovery targets every quarter by effectively evaluating liability and negotiating settlements

Analyzed risks associated with claims to determine if higher premiums were needed and submitted findings to the underwriting department

CANDICE GAINES

EXPERIENCE continued

Arbitration Specialist/First Notice of Loss Representative (FNOL) Adjuster

Infinity Insurance – Birmingham, AL July 2010 to July 2015

Arbitration Specialist

Promoted to Arbitration Specialist after one year as FNOL Representative

Responded to arbitration filings and filed initial arbitration applications for recovery aggressively pursuing adverse parties and carriers for recovery

Functioned efficiently under pressure, managing deadlines and multiple initiatives

Participated in the studies of evidence and other relevant documents provided by all parties and referenced applicable laws and similar cases to come to a reconcilable agreement

Worked with Risk Management to determine liabilities and risks within the department

Pursued subrogation recovery in one or more jurisdictions from other carriers, uninsured motorists, and other parties on auto, medical, and/or property claims

Wrote and distributed documentation that were adopted as standards within the agency’s guidelines

FNOL Adjuster

Accepted inbound calls from individual or business clients reporting first notice of loss

Completed initial investigation, entering accurate data into company’s’ customized database

Requested tows when needed and ordered police reports and other pertinent reports

Worked in shifts but remained on call 24/7 to provide best customer service

SKILLS

Customer Service

Claims Adjusting

Researching

Business Operations Practices

Risk Management

Problem Solving

Data Entry

Documentation

File Management

Record Keeping

Verbal/Written Communication

Microsoft Office Suite

EDUCATION

Bachelor of Science in Biology (Cum Laude)

Grambling State University – Grambling, LA

Contact this candidate