Customer Service Claims Examiner

Michelle Anderson

Mableton, GA ***** Phone: 470-***-****

Email: ady77n@r.postjobfree.com https://www.linkedin.com/in/michelle-anderson- licensedadjuster/

Licensed Adjuster with over 15 years of Claims Management

& Coaching Experience

Qualifications:

• Licensed Adjuster and Appraiser with over

15 years of experience – auto, property,

commercial (large trucks, GKL)

• Proven expertise in conducting in-depth

investigations and analysis of complex losses

along with proven expertise in claims

verification, dispute resolution, and fraud

detection

• Advanced knowledge of property and/or

highly complex claims handling procedures,

insurance operations, and claims operations

• Active Licenses: Currently hold 16 active

licenses for the following states:

AL, CT, DE, FL, GA- RESIDENT LICENSE,

KY, LA, NH, NM, NC, OK, RI, SC, TX, VT,

WY

• Achievements:

o Consistently achieving 100% on monthly audits and seen as subject matter expertise (SME) for claim operational excellence

o Consistently awarded by leadership for proactively identifying and reporting potential fraudulent claims in turn saving the organization in resources o Recognized and awarded for collecting on complex subrogation claims and returned fees while lowering insurers loss rations in turn resulting in customer retention

o Exceed industry standard for closing claims of one week to increase perfect annual audit score

o Consistently awarded Employee of the Month and Excellence in Service for demonstrating top-notch customer service

o Trusted partner in assisting leadership establish KPIs (key performance indicators) for claims department

o Expertise in identifying potential risk exposures and patterns from claims data, providing insights and recommendations for business risk mitigation strategies

§ Customer Satisfaction & Experience

§ Claims Handling & Management

§ Claims Reports & Documentation

§ Claims Investigation

§ Property & Casualty Insurance

§ Claim Investigation & Validity

§ Corporate Policies & Procedures

§ Data Gathering & Evaluation

§ Risk Assessment & Mitigation

§ Claims Resolution

§ Negotiation

§ Liability Assessment & Exposure

§ Legal Proceedings Knowledge

§ Attorney Communications

§ Fraud Detection

§ Relationship Building

§ Training & Development

§ Coaching & Leadership

§ Operational Efficiency

Professional Experience:

Senior Auto Claim Representative May 2023 – Present Selective Insurance Company, Charlotte, NC

• Receive, investigate, and initiate timely reviews of new complex assignments and then analyze policies, endorsements, and circumstances reported to determine coverages, limits, deductibles, and settlement calculations, as well as subrogation recovery opportunity, if any, apply to a particular claim and/or accident

• Assign and direct activities of internal and external resources as required, including independent adjusters and appraisers

• Conduct reviews and analyzes investigative information to determine if file is eligible for fraud/SIU handling and/or subrogation potential, as well as arbitration opportunity

• Solicit the assistance of vendors, attorneys, and/or other resources to help with remediation services or future analysis of damage or settlement values

• Assist leadership in the preparation of warnings and communicates effectively with employees on warnings and makes effective/appropriate decisions relative to corrective action as required

• Drive prioritization of work across the Claims organization, including establishing idea intake, prioritization, distribution, and feedback processes

• Follows up on action items to ensure projects remain on course and supports action planning and realistic goal setting when challenges arise

• Analyze and interpret data to identify trends and opportunities to improve claims processes

• Support leadership in establishing and maintaining work cadence, and ensure performance and outcomes strive for excellence in delivery and customer experience

• Provide support to leadership in performance management and development efforts for team members

• Identify opportunities to streamline processes, improve efficiency, and enhance customer satisfaction

Independent Appraiser August 2021 - November 2022

Progressive Insurance Company, Nashville, TN

• Investigated thoroughly to obtain relevant facts concerning all aspects of the claim, such as coverage, liability, legal climate, potential exposure, and damages, and makes decisions, where appropriate, on claim resolution. Monitors ongoing case development for appropriateness

• Processed total loss claims following Hurricane Ian requiring outstanding customer service and communication skills; explained services and interpreted policies

• Assisted the leadership in the continuous improvement of work procedures and processes that support the company and departmental standards, procedures, and strategic directives

• Gathered appropriate documentation to support the claimed damages through phone/email contact with customers, vendors, and police departments (includes estimates, proof of ownership/value, required company forms, reports, invoices, etc.)

• Provided recommendations to improve area operations to effectively service to both internal and external customers

• Played a pivotal role in quality-focused and efficient clean-up of 170K+ claims Express Associate November 2014 - August 2021

State Farm, Dunwoody, GA

• Analyzed and processed complex or technically difficult claims by investigating and gathering information to determine the exposure on the claim; manages claims through well-developed action plans to an appropriate and timely resolution

• Exercised proper judgment and decision making to analyze the claims exposure, to determine the proper course of action and to appropriately settle the claim

• Calculated and assigned timely and appropriate reserves to claims, monitors reserve adequacy throughout the life of the claim

• Responsible for searching claim files for potential subrogation potential and moving claims to subrogation for further processing

Previous Experience:

WNC First Insurance

Claims Examiner II July 2010 - November 2014

Claims Examiner I July 2007 - July 2010

GAP Examiner Specialist February 2005 - June 2007

Claims Representative I November 2004 - February 2005 Homeowners Insurance

Assistant Underwriter March 2004 - October 2004

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