Lawrenceville, GA ***** 404-***-**** email@example.com
Dedicated Claims Director with outstanding track record in Insurance and Risk Management fields offering extensive experience in managing claim departments and organizational risks; claim data analysis via data visualization tools; streamlining and standardizing work processes; and providing oversight to TPA's, vendors, attorneys, and US-based and global insurance carriers. Worked across departmental lines in various Director/Manager roles to determine liability exposures, evaluate damages and positively impact settlement values/jury outcomes in complex litigation. Worked with key stakeholders or led claim operations in gathering data, defining areas to improve, setting goals, establishing metrics and monitoring outcomes using data visualization tools. Skills
Data visualization tools (Power BI,
dashboards, ad hoc analyses, etc.)
Process improvement & workflow studies
Establish claim policies, procedures and
Complex claim handling
Collaboration with key stakeholders,
Strategic and analytical thought leader
Complex Claims Director 12/2021 to Current
AIG Insurance – Alpharetta, GA
Handle complex CGL, Auto Motor Carrier, Environmental, Aviation, Wrap (OCIP & Non-OCIP), and other policies for specific US and Canada based AIG insureds/accounts with large SIR's. Provide clear, concise, written and verbal communication to insureds, TPA's, brokers, excess carriers, underwriters, and defense attorneys facilitate effective claim-specific litigation strategies.
Write responses to contractual D&I tenders and request for AI from third parties and draft coverage position response letters to insureds.
Determine the scope and extent of available coverage and re-evaluate coverage as needed.
Prepare and execute investigation strategies on claims valued $2M - $12M which identify critical issues effecting liability, causation and damages and consider opportunities of third-party contribution/risk transfer.
Appropriately document evaluation, thought process, and strategy in the claim file and utilize ADR as appropriate.
Continuously strategize and budget the litigation process through discussions with counsel, vendors, and insureds.
Establish with defense and coverage counsel clear litigation plan to maintain financial control of budget and expenses.
Give guidance to insured and/or broker and TPA and establish/maintain working relationship them, managing expectations as appropriate.
Attend trials, mediations and strategy meetings.
Maintain nationwide knowledge of jurisdictional litigation environments. Liability Claims Manager 12/2016 to 12/2021
ABM Industries – Atlanta, GA
Had oversight responsibilities for TPA's, attorneys, insurance carries, in Aviation, GL, AL, Sexual Molestation, Employee Dishonesty, and Pollution & Crime exposures for US and UK based operations
Handled 70% of company's US litigation due to NE region Managed/tracked claim data via excel, GRA and Power BI tools and reported claim tends/risk exposures with Operations Leaders, collaborating with them to develop action plans to reduce risk and enhance safety measures
Developed and implemented Claims Review Tool (Excel book) to measure TPA performance, which later migrated to web-based application
Developed attorney scorecard using Excel to measure attorney performance and placed Aviation attorneys on new Tymetrix data management tool Through data analysis/tracking, persuaded Global Insurance Market (Aviation) to utilize lower-cost GL attorneys on routine slip and fall cases and new TPA, resulting in 50% reduction in litigation costs; change allowed for all claims to be on technological platform, with real-time management of claim files
Completed several workflow studies to enhance efficiency Managed 3 direct reports
Claims Manager 01/2014 to 12/2016
STAR & SHIELD CLAIMS SERVICES – Alpharetta, Georgia Part of original management team hired to open/manage newly formed SSCS for Florida-based P&C carrier in GA, Star & Shield Insurance Exchange (SSIE), within 90-day timeline Recruited/hired employees, filling multiple claim positions; created new hire training/development programs and maintained employee state licensing records Wrote multi-section, 454-page Claims Procedure Manual covering various claim topics, such as FNOL, ADP, PIP and Casualty claim standards, Medicare Compliance, and TIN processing Created 120 plus letter templates included in SSCS Letter Writing Package Served as Claims Compliance Director maintaining procedure/workflow manuals, tracking complaints, and recording Check and Claim Audits, Mail Quality Reviews, and Sox Compliance issues/findings
Established phone routing paths and FNOL Escalation standards, resolved phone problems, and processed operation's mail
Established accounts, processed invoices, and maintained relationships with 40 vendors (TPA's, Post Office, mail couriers, defense counsel, independent adjusters/estimators, investigation services, etc.)
Worked with outside vendor to create SSIE intranet site Supervised BI adjusters split-handling and adequately reserving AL and GL claims; worked closely with defense counsel and plaintiff attorneys to resolve complex coverage issues, serious injury exposures and litigated files
Claims Director 01/1987 to 12/2013
STATE FARM INSURANCE COMPANIES – Duluth, Georgia
Held 3 Director level roles: Field Auto Claims Director (managed 9 Team Managers supervising teams of field adjusters handling complex GL and AL claims, litigation and coverage questions), Claims Central Director (managed 189-personnel section with 11 Team Managers to handle high volume/low complexity claims in call-center), and Specialty Claims Director
(Subrogation, Claim Automation & Procedures, and Auto & Injury Claim Training Teams) Managed 11 first-line supervisors and 189 personnel in Fire Claims Central/Worker's Comp Operations
Created/implemented Excel Lawsuit Tracker that recorded costs/projected county trends Resulted in 60% increased use of house counsel and 2.7% reduction in litigation expenses Implemented multiple Claims Transitions Plans, consolidating facilities and reducing staff by up to 50%, while simultaneously maintaining employee morale and achieving company goals Seamlessly implemented Subrogation payment processing options (Western Union/credit card) that resulted in $2.3 mil in collections and boosted recoveries from 8.3% to 9% Implemented single electronic claim system for U.S.
Rolled out training programs, obtained end-user buy-in, and coordinated contact between Systems and Claims Developed/implemented 33 Diversity Audit initiatives Studied/implemented Agreed Fee Program for Georgia defense firms; used detailed WBS to ensure tasks completed as scheduled and relationship skills to enhance program understanding
Stepped in and reversed disastrous state of morale that prompted mass resignations; fostered a trusting work atmosphere, collaboration, diversity, open communication and inclusiveness that propelled customer/agency satisfaction to all time highs of 94% and 97%, respectively Education
Six Sigma - Green Belt: Process Improvement, Six Sigma 12/2011 University of Georgia - Athens, GA
Master of Arts Organizational: Management 2005
University of Phoenix - Atlanta, GA
GPA: 4.0, GPA: 4
Bachelor of Arts Political: Science, Business Administration Majored in Business Administration 1986 Indiana State University - Terre Haute, IN
Graduated magna cum laude
Rated Outstanding/Exceeds in every category for all Performance Reviews at SSIE Rated the highest (Exceeded Expectations - Level 3) at annual performance reviews 22 out of 26 times by 5 different supervisors at State Farm Insurance Recipient of four Special Achievement Awards for quality work on various high-profile projects at State Farm
American College of Financial Service, PA
Chartered Life Underwriters (CLU) Designation (2000) - Chartered Property and Casualty Underwriters (CPCU) Chartered Life Underwriters (CLU) Designation (1995) -
Insurance Institute of American (IIA) Designation (1993)