Claims Representative BI ADJUSTER

Maria Kelly

● ***** Apache Lake Dr. Katy, TX ****9 / ***********@*****.*** / 540-***-**** – Cell

SUMMARY

I am a UM/ BI/ Commercial Auto Claims representative, with 19.5 years claims experience, who utilizes exceptional listening and claim resolution skills, to handle first and third party PIP/ UMBI/ BI injury claims for unrepresented and attorney represented parties, in an expedited, efficient matter. I am posting for a position which will provide the opportunity for growth and advancement utilizing my proven years of claims experience. EXPERIENCE

AMERICAN ACCESS CASUALITY COMPANY:

June 20,2022 – Present

● Handle presented BI injury claims

● Conduct coverage and liability investigations on all claims

● Obtain recorded statements from all parties

● Set reserves

● Set PD appointments and field assignments, then have assigned to PD adjuster.

● Process coverage and liability denials when warranted

● Licensed in TX

● On ESI, fatality, and special claim handling team GEICO:

July 17, 2004 – June 13, 2022

● Handle PIP/MED/ BI/ UM BI and Commercial Claims under first and third party coverage for attorney represented and unrepresented parties.

● Conduct liability, coverage, injury, loss wages, loss of revenue and property damage investigations

● Thoroughly investigate all potentially fraudulent claims, and make the proper referrals to SIU if warranted

● Open proper exposures, set reserves, and issue payments

● Handle workman’s comp, Medicare/Medicaid, ERSA, hospital, and Child Support liens

● Complete CIQ, determine breeches, liability & shared negligence

● Complete coverage worksheets, review needed files with RLA, compose denial/disclaimer of coverage letters to insureds, and liability & coverage denial letters to claimants

● Respond to attorney letter of representations and demands

● Familiar with claim handling processes & liability laws in MD, DE, DC, PA, WV, LA, MO, WI, and TX

● Experienced in customizations, motorcycle, commercial, & RV claims

● Experienced in PRU, trained fellow associates in E-SUB hub processes, sent demands to adverse carriers, familiar with ARB Forums

● Trained CSR new hires as a CSR coach from March 2013 - Feb. 2014 QUALIFICATIONS

● Associate in General Insurance

● Strong analytical & problem-solving skills

● Strong attention to detail, time management and decision-making skills

● Strong organizational skills

● 19.5 years of handling liability & injury claims EDUCATION

● The Institute, AICPCU

* Associate in General Insurance

* ETHIC 311 - Ethics

* ETHIC 312 - Ethics and The CPCU Code of Professional Conduct

* INS 21 Series - Property Insurance

* INS 22 Series - Personal Insurance

* AINS 23 Series - Commercial Insurance

● Lone Star College

* Principles of Marketing MRKT

● GEICO University

* SIU Certified

* Great Communicator Series Certified

* Claims Professional Designation Certificate

ACCOMPLISHMENTS

● Worked and settled the most BI/ UMBI claims on the floor in 2020 (263)

● Top closer on ESI team in Jan, Apr, May, Jul, and Aug 2019

● Named " Employee of the Month " March 2005, within eight months of being hired, for excellence in promoting the Auto Repair Express Program, always being a team player and assisting team members with their diaries.

● Promoted to CSR2 in 2006

● Received Chairman's Club in 2009, 2010, and 2011

● Promoted to CSR Coach/Trainer in March 2013.

● Promoted to TCR1 in October 2014

● Named TCR1 of the 2nd and 3rd Quarter 2015, after joining the department in March of 2015.

* Put on special teams, handling complex coverage investigations, fatality claims, ESI claims, and UMBI claims 2023

Contact this candidate