Claims Adjuster Regulatory Compliance
Resume:
Lina Maria Carollo
Marine/Vessel/Boat Underwriter Risk Assessment Claim Adjuster
*** ******* ******, *******, ** 08053
609-***-**** ********@*****.***
Professional Summary
Experienced Marine/Boat/Vessel Insurance Underwriter & Senior Claims Adjuster Examiner with over 20 years of expertise in underwriting, claims Adjuster experience/ Adept at analyzing data, improving processes, and working across internal departments. Strong analytical and problem-solving skills with a deep understanding of insurance concepts, renewal processes, and regulatory compliance.
Professional Experience:
Geico-Goverment Employees Insurance Company
Boat Insurance and Marine Vessels- Insurance-Claims Adjuster/Underwriter-Florida-Remote Claims Adjuster/Underwriter- Marine Boat Insurance- FL-NJ- March 2013 - Present
● Review contract policies and amendments for accuracy and compliance before client distribuƟon.
● Analyzed policy language and made recommendaƟons and communicated them with stakeholders.
● Serve as a liaison with the sales team, providing ongoing support for new and exisƟng business.
● DraŌ policy change leƩers and underwriƟng decisions for clear client communicaƟon.
● Support underwriƟng audits and ensure adherence to compliance standards.
● Collaborate with senior underwriƟng leaders on referrals, new business opportuniƟes, and guideline refinements.
● Monitor underwriƟng performance, idenƟfying risk areas for porƞolio adjustments.
● Develop and maintain underwriƟng guidelines, reference materials, and centralized reporƟng dashboards.
● ParƟcipate in strategic cross-funcƟonal projects to drive process improve
● Prepared denial and approval leƩers and sent to policy owners.
● Managed, invesƟgated, and resolved auto and Marine/Boat Vessel/casualty claims. InvesƟgated and evaluates coverage, liability, damages, and seƩles claims within prescribed procedures and authority. Recommended ulƟmate resoluƟon on assigned cases in excess of their authority to local claims management and Home Office.
● Performed complete liability, coverage and bodily injury investigations. Reviewed and evaluated claim based on evidence obtained to determine responsible parties, liability exposure, questions of fraud or other pertinent issues
● Read, analyzed and interpreted insurance policies and endorsements, applicable state and local statutes, case law and applies to claim situations
● Ordered bills and reports from medical providers of injured parties, obtain police/ambulance/fire reports, medical histories and ISO reports to determine facts and prior accident information
● Prepared and maintained file documentation, communicates with insureds, claimants or attorneys regarding progress of claim. Negotiate settlements of claims with insureds, claimants and others up to authority limits
● Drafted reports to clients with recommendations for claim disposition
● Investigated and interpreted policy provisions, endorsements and conditions to make a coverage determination in the automobile property claim.
● Identified and investigated Contested Coverage Claims with recommendation prepared for coverage committee.
● Responsible for the investigation of the auto accident to make a liability assessment. This includes interviewing first and third party claimants, witnesses, investigating officers and other relevant parties, along with securing pertinent records, documentation and loss scene information.
● Analyzed the investigation to determine proximate cause, negligence, and damages.
● Evaluate and adjust reserves as necessary.
● Prepare dispatch instructions for field personnel to inspect vehicles.
● Negotiate and settle claims within his/her individual authority.
● Submit claims for approval to supervisor when over his/her authority or for guidance, review and/or referral when appropriate.
● Maintain an effective follow-up system on pending files.
● Prioritized and handled multiple tasks simultaneously.
● Adjusted to fluctuating workload.
● Advised insureds, claimants, brokers on the status of the claim.
● Acted as an intermediary between the Company, preferred vendors and customers.
● Resolved all disputes that may arise.
● Ensured that service, loss and expense control are maintained at all times.
● Adhered to privacy guidelines, law and regulations pertaining to claims handling.
● Investigated and initiated subrogation when applicable.
● Handled and responded to arbitration and special civil part lawsuits pertaining to property damage.
● Participated in catastrophic claim handling as requested/needed. This may include traveling to other locations and extended hours.
● Review Reserve Lines and Expsures and assign amounts.
● Medical Billing of insured injuries.
● Assist in ISU Investigations by providing evidence to case management.
● IdenƟfied potenƟal suspicious claims and refers to SIU and idenƟfies opportuniƟes for third party subrogaƟon.
● Prepared for and aƩended trials, hearings and conferences and reported to Home Office and local management on status.
● Conferred with trial counsel and prepared trial reports.
● Communicated with policyholders, witnesses, and claimants in order to gather informaƟon regarding claims, refers tasks to auxiliary resources as necessary, and advised as to proper course of acƟon.
● Responded to various wriƩen and telephone inquiries including status reports.
● Ensured adequacy of reserves. Recommended reserve increases on cases in excess of authority.
● Accountable for security of financial processing of claims, as well as security informaƟon contained in claims files.
● Responsible for managing the pracƟces and billing acƟviƟes of outside and in-house counsel.
● Assisted in the absence of the Claims Team Manager, represenƟng the company on maƩers involving state or federal regulatory agencies.
● Was involved in special projects and/or mentoring at the direcƟon of local management.
● 10+ years of liƟgaƟon experience
● Expert knowledge of handling personal lines claims with severe to catastrophic injuries and fataliƟes
● Expert knowledge of handling personal lines claims with severe to catastrophic injuries and fataliƟes
● Expert knowledge of coverage, liability, and complex claims handling procedures.
● EffecƟvely handle claims at the highest technical and complexity level.
● Knowledgeable of state and federal laws in the adjuster's jurisdicƟon.
● Full working knowledge of claims operaƟons and procedures.
● Excellent wriƩen and oral communicaƟons skills as well as strong interpersonal, analyƟcal, invesƟgaƟve and negoƟaƟon skills.
Senior Group Variable Life Insurance Administrator OCTOBER THREE CONSULTING/ DIVISION OF WILLIS TOWERS WATSON Remote - Chicago, IL
May 1998 - March 2013
● Reviewed and prepared annual and semi-annual financial reports.
● Managed insurance claims for policies ranging from $1.2M to $3M.
● Analyzed fund expenses, allocation, and financial forecasting for banking clients.
● Reviewed regulatory filings, including N-1A, N-CSR, N-CEN, and N-PORT for compliance.
● Coordinated with external departments to generate financial forecast reports and illustrations.
Skills & Competencies
● Software Proficiency: Project management software, underwriting systems
● ATLAS-GEICO-Claims ATLAS-SOFTWARE-SALESFORCE-FILESHARE
● Soft Skills: Team collaboration, conflict management, time management
● Typing Speed: 96 WPM
● Languages: Fluent in Italian
Education
Master of Science in Economics
New York University, New York, NY August 1998 - May 2002 Bachelor of Science in Business Administration & Management Boston University, Boston, MA August 1994 - May 1998
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