Customer Service Claims Processing
Resume:
professional summary
experience
Semmes, AL *****
W: ********@*****.***
Claims processing -property
Critical thinking
Policy interpretation
Investigative skills
Verbal communication
Liability and coverage
Coverage analysis
Microsoft Office Suite
Casualty and property loss
Policy investigations
File review
Computer literacy
Multitasking Abilities
Settlement negotiations
Time management
Complex Problem-solving
Determine coverage
Professional demeanor
Active listening
Insurance policy knowledge
MS office
Inventory documentation
Tracking inventory levels and orders
Delivery inspection
Shipment coordinating
Warehousing and delivery
Operating forklifts
Logistics software proficiency
Safety practices
Documentation skills
Proficient with SAP
Reverse logistics
International logistics
Logistics analysis
Distribution management
Shipment receiving
Decision-making
skills
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gregory l.
turner
g t
Dynamic Claims Examiner with extensive experience at Sedgwick - Aviva, adept at negotiating settlements and conducting thorough investigations. Proven ability in policy interpretation and critical thinking, ensuring accurate claims processing. Recognized for exceptional customer service and effective collaboration across departments, driving efficiency and enhancing client satisfaction.
Sedgwick - Aviva Memphis, TN
August 2024 - April 2025
Claims Examiner
Collaborated with other departments to ensure efficient handling of related issues such as large loss, supplement team, mitigation department, inspection, vendors, subrogation, and contractors. Review FNOL.
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Approved or denied claims according to company guidelines and regulations by determining coverage and preparing payment or denial letters.
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• Negotiated settlements with policyholders and claimants within authorized limits. Investigated potentially fraudulent or suspicious claims activities. Recognized coverage issues and brought to the attention of the supervisor.
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Evaluated and negotiated settlements of specified perils and property damage losses such as Hail/wind claims, daily, water claims, flood - Canada.
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Calculated claim amounts based on policy terms and conditions such as estimates from Xactimate collaborating to Xactanalysis software.
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Entered claim payments, reserves and new claims on computer system, inputting concise yet sufficient file documentation by Adjusted reserves or provided reserve recommendations by abiding by the policy limits.
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Provided exceptional customer service by keeping policyholders informed about their claim status throughout entire process.
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Calculated damages based on relevant factors such as repair costs, replacement value, and depreciation.
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Oversaw sound long-term claims strategies, effectively controlling expenses, loss ratios and litigation processes such as Additional Living Expenses and Large or Total Losses.
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Wardlaw Claims - AMFAM Waco, TX
September 2023 - August 2024
Claims Adjuster
Calculated damages based on relevant factors such as repair costs, replacement value, and depreciation.
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• Ensured timely processing of all assigned claims by established procedures and deadlines. Review supplement documents - contractors estimate, sub - quotes and photos to prepare a supplement request to supplement team for approval or denial.
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Customer service
Spreadsheet tracking
Invoicing and shipping
documentation
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•Guided clients through claims procedures and resolved minor complaints during the claims- handling process.
Negotiate supplement results with contractor and insured for approved or rejected payments.
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• Process payment via check or direct deposit to insured's, vendors or contractor's.
• QA review reject or approve estimates from field adjuster MID America Catastrophe Mobile, Alabama
September 2022 - July 2023
Desk Adjuster - Frontline
Calculated damages based on relevant factors such as repair costs, replacement value, and depreciation.
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Customer FNOL contact to discus policy limits, deductible and depreciation and process of claim handling procedures and next steps
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Schedule inspections and services with field adjusters, engineers, emergency services, and vendors.
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Review estimates and photos compare to cause of loss to justify or determine proper coverages or denials.
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• Letters - prepare denial, payment, and recoverable depreciation letters.
• Request payments with approved authority
• Process templates for transactions such as payment notes and authority note.
• Process payments to close claim
CRU Adjusters - TD Insurance Toronto, ON
January 2022 - August 2022
Claims Advisor
• Policy Interpretation
• File review for accurate payment, file & authority templates
• Open Exposures and Set All applicable reserves for ALE, Water, W & H, Condo & Trailer, Personal Property - Contents for Catastrophic Claims Processing
• QA and CA approve estimates with verifying damages for proper coverage
• Pay Vendor Invoices and Direct Settlements with insureds
• Evaluated damages and determined appropriate settlement amounts by processing payments to insureds and vendors.
• Settlement Calls
• Process Payments
• Set Reserves
• Review Policy to determine coverages
• Denial and Payment letters.
Alacrity Solutions Fishers, IN
June 2021 - December 2021
• File Reviewer
Examines documents, files, or data to identify issues, errors, or areas for improvement, ensuring accuracy and compliance.
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Follow up with Claims Handler on missing documents and corrections needed to bring file current and accurate for proper claim handling.
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• Review FA estimates for approval or rejections/corrections. AUSTAL USA Mobile, Alabama
July 2012 - May 2021
LOGISTICS ASSOCIATE II
education
• Quality control of packages coming into receiving via fedex, ups, etc.
• Receive indirect purchase orders
• Receive in mtu, olenburg parts.
• Misc. receive in ship loose parts in IFS.
• Pit boss receives material after receipt from crafts.
• Deliver material to crafts after the picking process is completed.
• Create non-conforming material cases and also follow up.
• Coordinated shipment schedules with carriers and customers to ensure timely deliveries. Resolved discrepancies between purchase orders, invoices, and receiving documents in timely manner.
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• Managed inventory levels to fulfill orders and maintain stock availability.
• Organized warehouse layout for efficient storage and retrieval of products. Ensured compliance with import/export regulations by staying current on customs requirements and documentation procedures.
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• Oversaw processing of customer orders, from order entry to delivery confirmation. AUSTAL USA Mobile, Alabama
January 2008 - July 2012
LOGISTICS ASSOCIATE 1
• Cycle Counts
• Review work orders
• Operate IFS Logistics Software system
• Operate Cribmaster Logistics Software Systems
• Receive all inbound materials and equipment by entering arrival reports for quantity and quality in to ERP System.
• Process and package equipment and materials for shipping, storage or installation as required.
• Issue and inventory consumable items.
• Communicate effectively with supervisors and company personnel.
• Prepare word and excell reports
MOBILE HOUSING BOARD Mobile, Alabama
July 2004 - August 2008
LOGISTICS CLERK
• Cycle Counts
• Received and Created Purchase orders in emphasys logistic software system.
• Planning physical layout of warehouse for storage of inventory and consumable to ensure accurate accounting.
• Created a paperless work order system that saved the company countless amounts of money in paper costs.
• Collaborated with team members to improve logistics processes.
• Supported purchasing department by verifying order details and delivery schedules. Bachelor of Arts (B.A.) - Business Administration
Southern University, Louisianna
Criminal Justice -
Florida State College at Jacksonville, Jacksonville, FL Accounting
Capella University, MN
volunteer
military
certification and licences
Vigor High School
January 2023 - Current
Band Director Assistant
Selected repertoire suitable for each ensemble's skill level while maintaining balance of musical styles throughout school year.
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• Mentored new teachers or student teachers within music department.
• Conducted rehearsals and performances for various school activities. Assisted with coordinating transportation logistics for off-campus performances or competitions.
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Provided constructive feedback to students on their performances during rehearsals and concerts.
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United States Coast Guard - November 1991 - December 1993 USCGC PEA ISLAND
USCGC LAUREL
USCG BASE MAYPORT
Certifications:
Value Management - 09/2018
Project Management - 07/2018
State Farm Property – 2024
State Farm Auto – 2022
Adjuster Licenses:
Florida - 2023
Texas All Lines – 2024
Mississippi - 2023
Alabama -2024
Louisiana – 2024
West Virginia - 2025
Oklahoma - 2025
North Carolina - 2025
Contact this candidate