Complex Liability Adjuster

Ms. Carisma Cousins

Complex Liability Adjuster

929-***-**** ******************@*****.*** Long Island City, NY Education

St. John’s University

Bachelor of Science in Law & Business May 2019

GPA: 3.3

Certifications & Licensures

● Certified All-Lines Adjuster (CALA) Certification, Kaplan Financial Education December 2023

● CPCU Candidate, The Institutes Knowledge Group 2025

● Project Management Professional (PMP), Greater Learning March 2023 Key Achievements

● Reduced fraudulent claims by 15% through advanced fraud identification strategies.

● Negotiated settlements for 95% of claims within authority limits, minimizing clients’ overall liability

(claim) costs.

● Improved claim accuracy by 20% through thorough assessments and investigations.

● Managed a $1.4M portfolio of commercial and residential property claims, ensuring timely resolution and client satisfaction.

Technical Skills

● Claims Software: ClaimsXpress, Xactimate, OnBase, CustomMatch

● Research Tools: LexisNexis, Westlaw, EagleView Software

● Microsoft Office: Word, Excel, PowerPoint, Outlook Hobbies & Interests

● Volunteer Work: Regularly volunteer at local business initiatives and pet rescue shelters.

● Hobbies: Hiking, kayaking, and mentoring college students. Professional Summary:

Resourceful General Liability Adjuster with nearly 5 years of experience in claims handling, risk analysis, and litigation management. Proven ability to manage complex claims, negotiate settlements, and maintain strong client relationships. Currently pursuing CPCU certification to enhance expertise in the insurance industry. EXPERIENCE

Self-Motivated multi-line insurance claims adjuster transitioning into education to strengthen strategic thinking, quick creative resolutions, and leadership and team engagement skills while happily serving my community and pursuing a CPCU certification. This shift allows me to grow professionally, contribute meaningfully, and return to insurance with sharper skills and a fresh perspective—prepared to take on greater challenges in the field. Catastrophe Claims Adjuster August 2023 – December 2024

State Farm Insurance Companies (100% Remote)

Licensed and specializes in Property and Casualty, catastrophic, and complex loss for multiple lines of insurance such as Boat, Commercial lines such as General Liability (CGL) and Commercial Property, Condo/ Co-op/Rental Dwelling, Homeowners, and Crop/Farm (land & assets) and other High-Value Assets. Negotiated resolutions with Attorneys, Design & Construction Contractors, 3rd party vendors, Public Adjusters, Policyholders, Agents (Brokers), Attorneys, Construction Corporations, and Subrogation Lines.

●Mentored inexperienced specialists and granted authority in the absence of People Leaders.

●Enforced advanced company standard fraud identification protocols, resulting in a marked decline in fraudulent claim occurrences

●Analyze information for action plans gathered by expert investigation teams and determine coverage analysis based on expert report findings and recommendations for an expeditious file closure.

●Virtually conduct complex property investigations to identify and classify damages for claims. Worked with policyholders, agents, field adjusters, contractors, public adjusters, and attorneys to administer property claims, maintain a point role, guide named insureds through the claims process, and resolve claims via denial, litigation, mediation, or settlement. It was ensured that all state-mandated deadlines were properly followed; from inception to completion.

●Provide coverage analysis for claims; review and assess insurance policy/coverage issues; recommend settlement and denials where appropriate; and negotiate resolution of files when provided authority.

● Draft and proofread claim investigation reports, Coverage Determination Letters, Release forms, Reservation of Rights letters, denial letters, negotiation and settlement offers, ROI/proof of loss letters, reports for approval, indemnity investigations, etc. Compose emails and correspondence to attorneys, clients, insureds, claimants, etc.

●Keep named insureds updated on claims, including initial telephone contact to reassure the insured and to gain information on the suitability of reserve, whether a desktop adjustment is appropriate, and if any initial undisputed payment is warranted.

●Oversee the financial aspects of claim files to ensure vendor payments and settlement drafts are issued and/or required funds are collected from clients.

●Set reserves to ensure appropriate values for each file; review and actively track reserves

●Ensure that all relevant items within the claims system are kept up to date, including diaries, alerts, milestones, reserves, and claims status, and any claim/procedural questions posed by adjusters, agents, and administrative staff.

Leveraging extensive insurance industry experience, transitioned to Software Development to acquire new indispensable skills and expand expertise, to enhance value for future employers. Litigation Analyst (Commercial, Liability and Medical Malpractice)January 2023 – April 2023 EmPRO Insurance Roslyn, NY (Hybrid)

Investigated, analyzed, and developed comprehensive malpractice and liability summary reports of the medical events, expert opinions, legal analysis, and insurance conflicts pre-trial and during court proceedings.

● Project Management: Frequently, partnered with a team of medical, legal, and risk analyst experts to develop the best strategy for expeditious case resolutions.

● Litigation Analysis and Claim Management: Additionally, generated over 355 loss run/claims history reports for individual practitioners or facilities and initiated data analysis via several different software programs that include eOasis, OnBase, the National Practitioner Data Bank, Dept. of Health, and fellow Bureau systems.

Took on the important responsibility of caring for my elderly parents. This experience enhanced my time management, organizational, and multitasking skills, as I balanced caregiving with personal and professional development.

Medicaid & Medicare Fraud Claim Examiner May 2021 – May 2022 Fidelis Care Insurance Co. (100% Remote)

Conducted daily health inspections, fraud analysis and investigation, reviews of hygiene practices on an average of 115 accounts for the company’s Managed Long-Term Care (MLTC) Medicare and Medicaid (contracted with New York State’s Dept. of Health. Resources). Resources sourced and administered include addiction counseling/ treatment, clinical/pharmaceutical supplies, DME/HME, home health aide services, hospice care, outpatient hospital services, and other vital services.

● Case Management and Fraud Analysis: To ensure compliance with DOH policies, analyzed, identified, and corrected non-standard, unethical, and negligent practices of aide and nursing home staff to implement comprehensive care plans successfully, and tracked down and coordinated critical resources to mitigate risks for socioeconomically disadvantaged, disabled, and elderly patients in crisis. Implemented detailed fraud identification strategies, decreasing the rate of fraudulent claims by over 15%.

● Patient Account Management: Led action plans, investigated, and managed patients’ 241 grievance claims and appeals in ref to caregivers and care providers. Finalized action plans, medical correspondence, and record maintenance.

Pursued new opportunities to align with financial goals. Commercial Claims Examiner (Auto, Repairs, BI, Property Damage, and TPA) Oct 2019 – April 2021 GNY Insurance Co. New York, NY (Hybrid)

Spearheaded an average rotating caseload of 130 claims monthly from start to finish verified policy coverage with brokers and insureds investigated the cause of the loss determined the appropriate settlement value of the claim to alleviate clients' liability exposure negotiated with claimants and their attorneys and supervised legal activity to the conclusion

● Investigations and Client Relationship Management: Managed a monthly ledger of liability claim accounts for a portfolio worth $1.4 billion which included commercial, business, and residential properties. Supervised legal activity and acted as clients’ liaison with the claims triage unit, trial unit, and P/D attorneys during the litigation process.

● Case Management: Developed action plans, researched, and gathered claimant-attorney confidential documentation, finalized invoicing, and various significant insurance correspondence, such as ROI requests, subrogation, and settlement documentation.

● Document Drafting and Preparation: Finalized and proof-read over 1,000 indemnification agreements

(indemnity), Reservation of Rights (ROR), and claim denials letters, personally managed attorney negotiation and settlement offers, ROI/proof of loss letters, notices, and direct claim settlements with claimants and attorneys.

● Sole point of contact for 500+ business, commercial line, and residential properties managed by agencies and boards.

● Anti-Fraud Review and Intake Examinations: Initiated and directed approximately 550 extensive investigations and evidence-based research projects to expeditiously dispose of cases, de-escalate/prevent liability loss exposure, and reduce client losses. Initiated and maintained rigorous fraud control strategies, greatly reducing fraudulent claim submissions.

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