Call Center Claims Adjuster

KS

KRISTINE SHIMO

*******@*****.*** 716-***-**** Cheektowaga, NY 14225

Experienced Claims Adjuster professionally handles minor to complex claims for customers. Adept at working directly with customers and providing guidance throughout the claims process. Committed to successfully managing a complex and diverse caseload and ensuring each party is satisfied with the outcome. Dynamic insurance professional bringing 8 years in the field of insurance with emphasis on automobile claims, RV, motorcycle, ATV/UTV, Low property coverage limits, rental and unlisted vehicles, coverage issues such as no coverage claims.

Experienced insurance professional with 8-year career determining liabilities in comparative negligence claims. Detail- oriented, observant and knowledgeable with excellent interpersonal and documentation skills. Efficiently handle high case volumes with accuracy and care.

Licensed Claims Adjuster (VT, RI, FL, TX, CT, MA, DL, but can also handle other states as well.) Positive attitude and exceptional problem solving skills.

Investigation management

Claims file management processes

Property adjusting

Fraud identification

Rules of evidence

Property claims

GEICO, Government Employees Insurance

Getzville, NY

TCR1 Liability Examiner

06/2014 - Current

Called insurance companies to find pertinent information regarding policies and payment benefits.

Paid and processed claims within designated authority level. Adhered to company and insurance client's guidelines in claims processes, estimate writing and claim closures.

Handled and processed variety of claims, including RV, Auto, Rental and other unlisted vehicles, Low Property Limits, UM/UIM BI, comparative negligence, 0-100% liability, ATV/UTV's.

Reviewed, evaluated and adjusted claims to promote fair and prompt settlement.

Entered claim transactions, payments, reserves and other documentation. Double-checked and reviewed documentation for denied and accepted insurance claims.

Investigated questionable claims to determine payment authorization. Completed required investigations on referred files within established timeframes.

Reviewed and resolved open claims and change orders to determine entitlement for additional payment.

Conducted daily reviews on claim files and verified sending of status letters to policyholders.

Gathered information from various third parties to determine claim acceptability.

Complied with company and insurance client's guidelines in claims Summary

Skills

Experience

processes, estimate writing and closing of claims, resulting in being very productive with my closures.

Analyzed first reports of loss and underlying file material to determine if claim was suspect.

Evaluated evidence with ultimate goal of creating positive outcomes for client's claims.

Researched and followed up on denied insurance claims. Evaluated acceptability of claims from third-parties and gathered comprehensive information.

Maintained thorough understanding of fraudulent and illegal practices. Examined claims investigated by independent adjusters. Was required to take anti-fraud training courses, conferences, client SIU training and industry seminar courses online.

KOLO DBS South Buffalo, NY

Dispatch Supervisor

05/2012 - 06/2014

Mentored, trained and managed team of 20 employees and offered insight and direction, helping boost overall performance.

Monitored attendance and productivity for employees by maintaining accurate and updated records.

Planned out driver routes ahead of time, which cut down on mileage and reduced costs.

Reviewed scope of each project to estimate number of man-hours required. Monitored dispatch board and adjusted call priorities regularly based on caller needs.

Tracked changes in computer system to keep records current and accurate. Reviewed routes, daily traffic and weather conditions to adjust plans, meeting daily requirements and service needs.

Supervised driver dispatching, route planning and vehicle tracking for over 50 drivers.

Communicated with individuals within inbound call center setting to complete dispatch support for towing and roadside service calls. Scheduled loads according to priority and available equipment. Responded immediately to emergencies by initiating outbound calls to police agencies and emergency contacts.

Recorded results of service calls to create report summaries for senior management.

Clarence Senior High School Clarence, NY

High School Diploma

07/2009

Genesee Community College Batavia, NY

Some College (No Degree) in Criminal Justice

Education and Training

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