Customer Service Representative

EVERS R. ARCHIBALD

Brooklyn, NY ***** 646-***-****

************@***.***

CAREER SUMMARY: Reliable, efficient, and multifaceted Claims Professional, with twenty-five-plus years of experience in the insurance industry, with a proven ability to adjudicate and apply Regulations 64 & 68, and their various amendments.

KEY SKILLS: Accurate Claim Adjusting, Data Analysis, Negotiation, and Customer Service skills; proficient in Microsoft Word, Excel, PowerPoint, and Outlook.

PROFESSIONAL HISTORY:

Insurance Auto Adjuster/Appraiser; First Metro Adjusting Company, 11/2021 - Present

Evaluate and appraise automobile damages resulting from auto accidents on behalf of various Insurance Companies.

Bodily Injury/Legal Examiner; The Best Claims Solutions/MTA Bus Company, 10/2018 - 9/2021

Reviewed and referred various S&Cs to the appropriate MTA Legal Departments;

Drafted denials for Non-MTABC accident claims, upon receipt of the Notices of Claims;

Processed various attorney’s invoices.

Expedited requests for MTABC’s employees' employment and payroll records.

Property Damage Examiner; Park Insurance Company 10/2017 – 9/2018

Adjudicated 3rd Party Property Damage auto claims, from inception through completion;

Interviewed and retained various auto appraisal vendors;

Initiated and processed PD Subrogation claims from inception through completion.

Account Executive; The Solution Experts of New York, 7/2014 - 10/2017

Scheduled and coordinated IME appointments for various claimants;

Processed Hospital DRGs, No-Fault Medical bills, and Peer Reviews, according to the New York State N/F Fee Schedule.

Claims Specialist; Insurance Recruiting Specialists/Liberty Mutual Insurance Company, 11/2010 - 1/2014

Medicare Screening Project:

Identified and processed various eligible G/L claims for Medicare reimbursement;

Submitted various Excel Spreadsheets to the Medicare Department.

Claims Manager/BI Examiner; Maya Assurance Company, 9/2006 - 7/2010

Monitored and adjusted claims reserves, based on the severity of each claim;

Adjudicated Bodily Injury Claims from inception through completion.

No-Fault/Pip Supervisor; Eveready Insurance Company, 5/1996 - 8/2006

Managed Eleven No-Fault Examiners and Support Staff members;

Managed IME procedures and protocols for cost-containment adherence;

Identified and red-flagged cases for E.U.O. and/or SIU referrals.

EDUCATION:

New York Center for Financial Studies;

St. Kitts Business College.

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