Customer Service Claims Specialist

Kaleem Raheem

Cave Creek AZ *****

Professional Summary:

Results-driven insurance professional with over two decades of extensive experience in claims management and risk assessment.

Demonstrated success in optimizing claim handling processes, reducing litigation costs, and achieving favorable outcomes for both clients and the company.

Adept at providing strategic leadership, mentoring teams, and fostering a culture of excellence in customer service.

Proven track record of exceeding performance targets and delivering exceptional results in high-volume, fast-paced environments.

Seeking to leverage expertise and leadership skills to drive operational efficiency and contribute to the continued success of an insurance organization.

Education

Illinois State University – Normal, IL

Bachelor of Science in Political Science

Minor in Sociology

Elgin Community College- Elgin, IL

Associates of Arts

Professional Experience:

USAA Insurance

Senior auto adjuster July 2024 –

. Investigated, evaluated, and settled complex coverage, liability, and damages for auto complex claims.

. Received 20-25 inbound calls from various parties involved in the auto claims from a team queue.

. Managed about 95-110 claims in pending inventory for first party claims of collision/rental and third party

Property damage claims

. Set up vehicle appraisal and rental reservations and resolved any vehicle and rental issues.

. Respond to requests from subrogation unit to provide any coverage, liability, damages clarification.

. Process total loss claims in partnership with COPART and CCC vendors and coordinate storage, towing,

And salvage assignments.

Selective Insurance Nov 2023 - Jan 2024

Auto Insurance claims specialist

Investigated, evaluated, and settled coverage, liability, and damages of auto insurance claims in 48 states for commercial auto insurance policyholders.

I had systematically overhauled the claim operations by responding to a significant number of claims that had outstanding time limit demands that were not timely addressed

I promptly identified customer needs, wants, concerns, and expectations by applying appropriate strategies to gain the trust, confidence, and cooperation of customers

I was able to convince attorneys to settle BI claims well below their original policy limit demands when I adequately justified policy limit demands were not warranted in the claim value

Set up vehicle inspection, appraisals, rentals, and issued payments for property damage claims and settled bodily injury.

Settled about 30 bodily injury claims from transferred files that were not worked in several months.

Diligently resolved customer conflicts, disputes, and complaints pertaining to coverage, liability, and

Travelers Insurance Jan 2023 - Nov 2023

Inside Claim Representative

Investigated, evaluated, and settled coverage, liability, and damages for bodily injury claims in personal insurance for 11 states.

I was able to effectively and efficiently negotiate comparative negligence with adverse carriers who had originally denied any liability

I had devised investigation strategies that uncovered the truth about what happened with many insufficiently investigated claims

Set up vehicle inspections, appraisals, rentals and issued payments for vehicle repairs. Answered calls, emails, and texts and provided guidance, help, and support in the claims process.

Had the lowest inventory of claims and had a closing ratio of 98%. Completed 95% of contacts within 8 hours of receipt of an insurance auto claim reported.

Diligently resolved customer conflicts, disputes, and complaints pertaining to coverage, liability, and damages.

Provided exceptional customer service. Had received 94% outstanding audit reviews on quality file documentation.

Cincinnati Insurance Company, Cave Creek, AZ. Oct 2019 – Oct 2022

Senior Claims Specialist

Ensured efficiencies and quality in claim investigations, evaluations, and settlements of personal and commercial auto, property, general liability, and construction defect claims.

Ensured I was adequately and effectively conducting coverage, liability, and damage investigations, evaluations, and resolutions for commercial and personal auto and property, general liability, and constructive defect exposures.

Oversaw claim associates resolve coverage, liability, property damage and injury disputes with independent agents and their account managers.

Consistently assisted and guided claim associates to develop and maintain professional development, ongoing progress, advancement, and success in their respective roles in the claim operations which produced some of the highest levels of operational performance in the organization.

Safeway Insurance Company, Mesa AZ. Oct 2017 - Oct 2019

Claims Representative & Training associate.

Oversight of outside counsel utilization, injury claim severity, claim life cycle, managing injury claim practices consistent with internal standard claim practices.

Developed claim leadership across multiple divisions by providing strategic guidance and preparing claim associates to deliver on established strategies.

Designed metrics to produce efficiencies with claim handling processes, reduced litigation costs, enhanced claim handling processes and facilitated desirable and favorable claim resolutions.

Supervised injury investigations, evaluations, negotiations, and settlements and litigation management by claim staff and outside counsel.

Assisted in the training and development of claim adjusters to learn bodily injury evaluation and negotiation, claims system, procedures, processes, and customer services.

Oversaw the development of claim associates, formulated individual development plans, continuous education, arbitration/trial appearances and experiences exposure and increased claim authority.

Analyzed and authorized BI settlements for complex BI and UIMBI claims, theft losses, non-permissive use, out of state claims, intentional acts, and other coverage issues.

USAA Insurance – Phoenix, AZ Jul 2014 - Oct 2017

Senior Claims Specialist

Investigated, evaluated, and settled property damage claims in 11 different states.

Managed 40-60 inbound calls and made 30-40 outbound calls in a high claim volume operation.

Demonstrated proper empathy for caller’s situation, reactions and circumstances and acknowledged the difficulties and inconvenience associated with automobile accidents.

Put the caller’s mind at ease by taking the initiative to help them with confidence and reassurance.

Set clear expectations of coverage, liability, vehicle inspection and claim settlement process.

Set clear expectations for the payment process so member understands their financial liabilities.

Achieved 92% closing ratio which was one of the highest in the non-injury operation.

Mentored new adjusters in training, developing, and evaluating performance in overall claim handling.

Adopted a systematic approach to coaching by forging a partnership that build trust and understanding which allows people to know that you are interested in them, inspiring commitment to build insight and motivation so that people are committed to change and focus their efforts on goals that matter to them and the organization, growing competencies by identifying effective ways to learn new knowledge and to develop skills and capabilities, promoting persistence to support people in their development even when they get discouraged or diverted, and shaping the environment to build organizational support to reward learning and remove barriers.

American Family Insurance – Englewood, CO Apr 2010 – Apr 2014

Senior Casualty Adjuster

Investigated evaluated and settled property damage and bodily injury claims in Colorado, Utah, and Idaho managed a volume of claims from 50-60 claims to 100-120 claims monthly.

Maintained a balanced approach in a high-volume claim operation handling an inventory of 100 claims or while successfully maintaining the demands of handling 30-50 phone calls, responding 10-15 emails daily and handling anywhere from 40-50 claims weekly with minimum management supervision.

Received 2 “Superstar awards” for recognition for providing exceptional customer service.

Achieved above goal of 50% customer placement into our preferred shop programs causing an increased financial growth in 2013 and 2012 for the company.

Achieved 75% above goal in customer service “Touchpoint” surveys in 2014.

Achieving 100% ratings in audit results as it pertains to casualty coverage, liability investigation and analysis and exposure recognition as well as 100% in proactive & reserve handling in 2012 and 2013.

SXC Health Solutions– Lisle, IL Oct 2010 - Apr 2010

Customer Care Professional

Maintained a clear understanding of each client’s policies, procedures, and individual needs.

Assisted pharmacies and/or clients in resolving a variety of daily processing obstacles. Collected accurate information and document unresolved issues. Worked with teammates, Account Managers and other resources to solve those issues.

Maintained records of actions taken including documenting clients' calls in Customer First, member prior authorizations, modifications to records within the RxCLAIM system, and call tracking notes regarding pharmacy calls received using AS/400 system.

Filed and maintain paper records in an organized manner.

Innovation Group – Chicago, IL Oct 2008 – Oct 2010

Customer Service Representative

Answered incoming calls and provided distinguish customer service and conflict resolution.

Managed work queues daily to ensure all claims are kept current and maintained production and quality standards.

Processed auto claims according to account process and procedures.

Consistently maintained service level agreements with all our account holders process and procedures.

Promptly available to answer 30-40 incoming calls and effectively engaged in conflict and dispute resolution.

Increased customer satisfaction by 30% from favorable survey ratings conducted during my tenure.

Efficiently investigated and processed 15-20 automobile damage claims daily and established prompt contacts with customers less than one hour of receipt of a new claim.

Successfully reduced complaints in the operation by over 50% through expedited coordination of vehicle inspections within 24 hours of reported damages.

State Farm Insurance Elmhurst, IL Jul 2001 - Mar 2008

Claims Specialist

Investigated a substantial number of claims, evaluated injury claims based on sound reasoning, objective analysis and effectively settled bodily injury claims.

Negotiated and settled bodily injury claims with attorneys/claimants involving simple and complex injuries.

Formulated strategies to achieve a balanced focus on files and workload; while being available to service customers on the phone 80% of the time.

Actively engaged in organizations to develop broad experiences that contributed to my professional development.

Senior Claim Representative

Analyzed auto policies to verify coverage, evaluated legal liability and extent of damages to persons and property.

Consistently identified opportunities to expedite claim resolution and effectively decreased workload.

Resolved inconsistencies in claim files by uncovering inaccurate and incomplete information.

Actively participated in the mentoring program by becoming a mentor to some new claim adjusters.

Claim Representative

Executed approximately 300 subrogation files involving property damage and medical recoveries.

Negotiated liability and subrogation recoveries from insurance carriers and uninsured claimants.

Reduced inventory by 15%-25% every month through efficient and aggressive recoveries

Contributed to a monthly recovery of over $100,000, in turn, an annual recovery of over $1 million dollars.

Collaborated with agent offices and explained how the subrogation process reduces loss ratio.

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