Quality Assurance Specialist Ii
Resume:
Michael E. Anderson
Missouri City, Texas 77489
************@***.***
CAREER OBJECTIVE:
Ability to utilize over 30+ years of experience in the insurance industry while seeking a challenging new position that will allow growth and expand my professional, managerial, and communication skills. SKILLS:
Computer Proficient, accustomed to fast-paced environments, outstanding leadership, analytical and communication skills. Diverse in multiple insurance policies and have a strong background in policy interpretation (Litigation, Commercial Auto and Personal Auto, Residential) Professional Experience:
Stillwater Insurance May 2022 - May 2024
Liability Examiner, Houston, TX
Determined coverage via verification and detailed analysis of applicable policy/endorsement contract language in comparison to claim facts
Promptly resolved all open coverage issues through the investigation process
Timely drafted and issued the appropriate reservation of rights, disclaimer, or partial disclaimer position letters in conformance with insurance regulations and market requirements.
Helped resolve problems in a timely manner
Ensured enterprise financial accountability through timely and adequate claim and expense reserving practices
Timely initiated, conducted, and completed investigations on both transfer and claims assigned from the ground up.
Followed supervisory guidance on managing the legal expenses of defending and resolving lawsuits as well as avoidance of unnecessary litigation:
Drafted and timely completed necessary claim narrative reports to the claim files, reinsurers, and claims management.
Utilized Xactimate estimating skills sufficient to write a roof or water loss estimate from a pre-generated sketch. Commit to develop your Xactimate and damage measurement skills over time.
Ensured claim administration standards are met by compliance with all Unfair/Fair Claim Practice Acts and Insurance Code Regulations.
Maintained staff adjuster licenses and complete continuing education requirements as required by the States assigned.
Nationwide Insurance May 2013 - November 2021
Casualty Claim Specialist II, Houston, TX
Investigated, evaluated, negotiated, and brought to final resolution complex and catastrophic casualty losses
Successful / exceptional performance, especially in key areas such as Claims Quality Assurance and Customer Focus
Demonstrated understanding of and adherence to Claims Best Practices and Reserving Best Practices
Demonstrated understanding of Complex Case Escalation and Informing Practices
Passionate for teamwork; participating in projects, mentoring, training and/or other opportunities to help the team develop and improve
Experienced in handling California, Texas, Arizona, Nevada, Utah, Washington, Iowa, New Mexico claims
State Farm Insurance – Prime Consulting Group, Inc. January 2012 Auto Liability Bodily Injury Claim Representative, Dallas, TX
Verified facts of accident and investigate liability accident disputes.
Determined and explained policy coverage and reviewed insurance contract.
Took recorded statements, interviewed witnesses and claimants.
Interacted with insured, claimants, medical insurers, attorneys, and body shops
Reviewed and reconciled property damage repair estimates. Ignite Restaurant Group August 2010- January 2011
General Liability Claims and Guest Relations
Specialist
Worked as a Staff Adjuster using Risk Management system to manage an assigned case load focusing on Guest Relations and Claims Management. Includes, making decisions about liability/compensability, evaluating losses, and negotiating settlements.
Managed the guest relation’s process by entering customer comments into guest relations matters into database, forward comments to assigned department/division/management, and provide regular status updates to customers.
Provided management with weekly and monthly reports pertaining to customer relations issues and guest claims from the 115 restaurant locations.
Occasionally attended depositions, mediations, pre-trials, trials and all other legal proceedings, as needed acting within established professional guidelines with knowledge of the applicable state laws.
Insurance Recruiting Specialists (IRS) – July 2009 – July 2010 Liberty Mutual Insurance Company
Auto Liability Bodily Injury Adjuster - Houston, Texas
Handled complex liability and litigation claims in Texas and Louisiana
Personal Lines Auto claims handling
Investigated and evaluated personal, casualty or property loss/damage insurance claims under limited supervision
Eberl’s Claim Service March 2009 – Active
Independent Claims Adjuster (Auto Claims), Lakewood, Colorado
Adjusted catastrophe auto loss claims
Farmers Insurance Group May 2004 – June 2008
Special Claims Representative (Commercial Auto/ Personal Auto Liability) / Bodily Injury & Litigation Specialist, Houston, Texas
Oversee claims process specializing in complex litigation.
Identified, compiled and managed information regarding claim adjustments for all types of Commercial Automobile Liability Claims.
Adjusted Bodily Injury claims to conclusion through negotiations and/or litigation.
Conducted detailed risk analysis and interpretation on assigned cases and provide claims management advice.
Provided training and coaching for Commercial Claims Representatives.
Performed detailed insurance contract review including indemnity agreements.
Interpreted plaintiff complaints and petitions.
Prepared claim status reports detailing coverage issues and determining overall liability.
Acted as a liaison between company and clients to negotiate and finalize settlements.
Skilled Arbitrator
Unlimited Home Care, Inc. November 1999 – November 2003 Director of PHC (Personal Health Care), Houston, Texas
Handled day to day operations of the Home Heath Care business in the Patient Provider Care programs.
Prepared and reviewed patient medical documentation to initiate services for new and transfer patients under the guidelines of the Texas Department of Human Services.
Responsible for department budget and employee payroll.
Performed patient evaluations and employee performance reviews.
Managed staff of 25 employees which included recruiting, training and supervising. State Farm Insurance Company February 1991 – November 1999 Claim Specialist – Personal Auto Liability -Auto/Bodily Injury Claims, Houston, Texas
Responsible for adjusting Automobile Liability Claims including bodily injury, property damage, PIP and Med Pay.
Conducted claims investigation by analyzing coverages and determining liability.
Member of the Catastrophe Response Team.
Completed Pepperdine University ADR & Negotiations Seminar. Education:
12/1988 University of Texas at Austin, B.B.A., Education Affiliations:
Licensed Adjuster in the State of Texas, Oklahoma and California
*State Farm Auto Certification
*Allstate Auto Certification
Serves on University of Texas Exes Black Alumni Association Board Of Directors
University of Texas Exes Alumni Association - Life member
Omega Psi Phi Fraternity; Life member
Past Vice President, Past Treasurer First Colony Broncos Youth Football; Board of Directors, Sponsorship Director, Merchandise Director; Coach (9 years)
West Sugar Land Little League; Baseball Coach (5 years)
YMCA (Houston & Missouri City, Texas); Coach (5 years) – Basketball and Flag Football
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