Customer Care Service

KAREEMA ARKEL

Union City, GA *****

470-***-**** - ************@*****.***

PROFESSIONAL SUMMARY

A motivated adjuster with goals to maintain customer satisfaction and exceed company goals. Ability to establish long term rapport with injured claimants, medical providers, and attorneys. Fostering a positive experience with high quality customer care with prompt resolutions of complaints, negotiations and claims, highly skilled with injury claims from start to end – investigating the claim, liability analysis, weekly follow ups, negotiating the claim, settling claims directly with attorneys and customers. WORK HISTORY

05/2024 to 01/2025 Senior Resolution Specialist

PRG/ Gallagher and Bassett

Worked with compliance and legal departments to handle sensitive issues and legal proceedings.

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Implemented new software tools to automate aspects of the resolution process, increasing efficiency across the team.

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Served as a subject matter expert on dispute resolution, advising colleagues on best practices and industry trends.

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Leveraged advanced problem-solving skills to address difficult or escalated cases, ensuring customer satisfaction.

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Provided exceptional customer service while managing a high volume of inquiries from clients regarding disputes or complaints.

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Assisted in developing standardized scripts for consistent communication with customers during the resolution process.

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• Compiled data on trends and identified potential enhancements. Improved customer satisfaction by efficiently resolving complex issues and providing timely solutions.

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Negotiated settlements between disputing parties, balancing the needs of both sides while upholding company policies.

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Reviewed legal documents and contracts to determine potential conflicts and disputes.

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Used mediation techniques to facilitate communication between disputants, to further parties' understanding of different perspectives and to guide parties toward mutual agreement.

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01/2021 to 03/2024 Claims Adjuster

Jones Group/Gallagher & Bassett

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

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• Investigates, evaluates, disposes and settles the most complex claims and highest exposures with minimal supervision Includes the determination and evaluation of coverage, liability and damages, and the setting of proper reserves

• Interacts extensively with various parties involved in the claim process Able to clearly communicate concise action plans, and present plans for moving the case to conclusion

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Will demonstrate complete knowledge of the claim file process through presentation of actions and responses to client questions

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Processes claims consistent with clients' and corporate policies, procedures and

'best practices' and also in accordance with any statutory, regulatory and ethics requirements

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• Demonstrated ability to comply with carrier reporting and threshold requirements

• Able to recognize and pursue excess insurance recoveries Incumbents will have the ability to handle a full case load, with proven ability to handle cases of increased severity

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Claims reserve and settlement authority of up to $20,000 liability and/or $50,000 workers compensation or greater

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Negotiated favorable settlements with claimants, attorneys, and other insurance carriers to minimize financial risk for the company.

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• Examined claims forms and other records to determine insurance coverage. 01/2018 to 01/2021 UM/UIM/Litigation Claims Adjuster Allstate Insurance Co.

Investigating complex claims when an attorney is representing the injured party including - (UM/UIM) claims in single or multi car accidents; (2) Injury Casualty Soft Tissue and represented - moderate or major claims, complex Commercial Property Liability

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Documents a claim file with notes, evaluations and decision making process Coverage, Liability and Evaluation

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Determines and explains minimum coverage limits in complex claims involving single or multiple claimants

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• Sets initial reserve, updates reserve, documents rationale and claim summary notes

• Obtains photos and/or conducts scene investigation Takes recorded statements from claimants, insureds, witnesses, medical providers, conducts investigations into complex auto accidents, determines liability and prepares summaries

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Evaluates and determines potential use of experts; reviews reports and participates in selecting the expert

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• Determines claim value

Reviews file to identify complex potential legal issues Negotiation and Settlement Guidance

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• Negotiates and settles claims in accordance with business unit best practices

• Reviews medical reports in preparation for claims settlement evaluation 01/2013 to 01/2018 Claims Adjuster (Remote)

Allstate Insurance Co.

• Working independently and directly with attorneys to negotiate and settle claims Investigating single and multi-vehicle auto accidents to determine the at-fault party with reviewing photos and obtaining recorded statements

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• Negotiate with claimants or their attorneys

• Settle claims and set reserves

• Estimate cost of treatment or compensation for those injured in accidents Analyze and interpret medical reports, follow up with no-fault parties, and manage claims process to ensure efficient resolution

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Interview, collect and document information from various people such as claimants, agents/brokers, attorneys, and police

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Evaluating claims reviewing medical records and bills and concluding a settlement offer directly with the patient

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Responsible for workers compensations demands, reviewing medical treatment related to the loss approving and denying certain treatment received

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Reporting claims with other carriers, responding to their request in professional and timely manner

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Managing claim recoveries of all types, subrogation demands, medical providers liens, Medicare/Medicaid liens, Med Pay / PIP offsets and child support lien offsets

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Detail oriented with strong organizational management skills, able to work well under deadlines in a changing environment and perform multiple tasks effectively and concurrently

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Maintain accurate documentation/information in claim file and claims system as per claim handling requirements including coverage analysis, proper damage and liability evaluations, proactive resolution management and settlement rationale

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01/2009 to 01/2013 Claims Express

Allstate Insurance Co.

• Thoroughly analyze, investigate, negotiate and resolve claims

• Provide world class customer service to insureds, agents, brokers and underwriters Maintain accurate documentation/information in claim file and claims system as per claim handling requirements including coverage analysis, proper damage and liability evaluations, proactive resolution management and settlement rationale

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Identify recovery management opportunities in the earliest stages of claim development

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Retain, monitor, manage and approve payments to outside counsel actively utilizing litigation management plans and budgets

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Maintain knowledge of coverage law, legislative and industry-related initiatives and judicial trends and provide claim updates and coverage interpretation to regional underwriters

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Verify coverages for customers or verify that policy changes were made and provide proof of evidence of insurance documents to customers where coverage previously bound by a licensed producer

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EDUCATION

bachelor's degree: Business

Strayer

Certificate: Medical Coding and Billing

Erie Community College - Buffalo, NY

CERTIFICATIONS

• Adjuster's License, Florida, #FL921060Z

• Adjuster's License, Georgia, #0330000

Microsoft Excel Lotus 123, MAS500, Sage Payments, NextGen, ISO, Mitchell, Collosus, Oracle, Main frame and Internet.

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