Summary
Overview
Work History
Education
Skills
Timeline
Generic

Calisha Marie Baker

Douglasville

Summary

Senior Property Claims Adjuster with extensive experience at Liberty Mutual, specializing in claims handling and settlement negotiations. Demonstrated success in fraud investigation and risk assessment, ensuring compliance and enhancing customer satisfaction. Skilled in collaborating with cross-functional teams to resolve complex claims effectively.

Overview

12
12
years of professional experience

Work History

Senior Property Claims Adjuster and Risk Manager

Liberty Mutual
01.2023 - Current
  • Handled and processed a variety of claims, including property and auto.
  • Reviewed, evaluated, and adjusted claims to promote fair and prompt settlement.
  • Double-checked and reviewed documentation for denied and accepted insurance claims.
  • Completed required investigations on referred files within established timeframes.
  • Evaluated evidence with the ultimate goal of creating positive outcomes for the client's claims.
  • Entered claim transactions, payments, reserves, and other documentation.
  • I researched and followed up on denied insurance claims.
  • Verified and analyzed claims settlement data to ensure validity.
  • Communicated with personnel and legal counsel on claims involving litigation.
  • Investigated questionable claims to determine payment authorization.
  • Evaluated the acceptability of claims from third parties and gathered comprehensive information.
  • Supervised independent adjusters to promote adherence to guidelines.
  • Analyzed risk factors to enhance decision-making processes.
  • Collaborated with cross-functional teams to identify potential risks.
  • Monitored compliance with industry regulations and standards.

Liability Claims Adjuster

Allstate Insurance Co
01.2021 - 01.2023
  • Investigated liability claims, and determined coverage based on policy language and applicable law.
  • Identified potential responsible parties, conducted interviews, gathered evidence, and evaluated damages.
  • Negotiated settlements with claimants, attorneys, and other representatives.
  • Drafted letters of denial or explanation of coverage for auto liability claims.
  • Reviewed police reports, witness statements, accident reconstruction reports, and other documents related to an incident.
  • Prepared detailed summaries of each claim file, including all pertinent information regarding coverage issues, liability determinations, and damages calculations.
  • Monitored payment activity to ensure timely resolution of claims within established guidelines.
  • Provided customer service support to insureds by answering questions about their claim status, or providing additional information as needed.
  • Maintained contact with clients throughout the life cycle of a claim in order to keep them informed of its progress.
  • Participated in periodic audits that ensured compliance with departmental standards and procedures.
  • Adhered strictly to all state regulations concerning timely filing requirements for auto insurance claims.
  • Continuously updated knowledge base through research, webinars, seminars, or other training opportunities.
  • Provided quality customer service to assigned insureds and claimants throughout the claims process to deliver timely service to customers.
  • I interviewed and spoke with claimants, witnesses, police officers, doctors, and other parties to determine claim settlement or denial.

Desk Adjuster/File Examiner/Mediation

PLS-UPC
12.2017 - 12.2020
  • Pre-litigation, public adjusters, complexity, large loss.
  • Reviewed files and endorsements to ensure coverage and eligibility were met to approve payment.
  • Electronically entered payments on submitted documents and photos to be reviewed for claim settlement.
  • Communicated effectively with attorneys to resolve the claim.
  • Worked with contractors and general contractors with supplements due to missed components.
  • I consulted with building consultants for comparative estimates on large loss and complexity claims.
  • I consulted with engineers to determine the cause of the damages.
  • Negotiated with attorneys and a public adjuster to settle the claim with an executed, signed release.
  • Work closely with mediators to reach an agreed settlement.
  • Resolved claims in pre-litigation.
  • Alternative dispute resolution.
  • Responded to the complaints filed with the state department of insurance.

Desk Adjuster/File Examiner/Condo Commercial

DMA Claims Services
12.2016 - 12.2017
  • Reviewed files and endorsements to ensure coverage and eligibility were met to approve payment.
  • Electronically entered payments on submitted documents and photos to be reviewed for claim settlement.
  • Entered information on submitted claims to ensure the timely progression of claim determination and eligibility.
  • Ensured that compliance standards were met for all claims.
  • Submitted the file for payment after all documentation was submitted and attached to the file.
  • Reviewed master policy and by-laws.
  • Communicated effectively with the HOA.
  • Processed Business Interruption claims.
  • Worked with forensic accountants.
  • Reviewed Schedule C, bank records, P&L statements, and sales records.
  • Calculated projected gross sales for the loss year.
  • Calculated projected gross expense for the loss year.
  • Calculated projected net profit for the loss year.
  • IEM QA/QC/Desk Examiner – Restore Louisiana Project 2017.
  • Reviewed files and endorsements to ensure coverage and eligibility were met to approve payment.
  • Electronically entered payments on submitted documents and photos to be reviewed for claim settlement review
  • Provided courteous customer care
  • Entered information on submitted claims to ensure the timely progression of claim determination and eligibility
  • Ensured compliance standards were met for all claims
  • Submitted file for payment after all documentation submitted and attached to file.

Loss/Earthquake Desk Examiner

Pilot Catastrophe Services
12.2014 - 12.2016
  • Identifies when to retain, manage, and direct other vendors necessary to resolve claims, including contents specialists, accountants, contractors, appraisers, salvage specialists, restoration specialists, cause and origin specialists, and coverage counsel
  • Daily review of workflow and claim system reminders with follow up and significant progress toward completion of any task set as a reminder or received in workflow within 72 hours
  • Review of new claims assignments within 24 hours of assignment/Completion of the Plan of Action
  • Contact with the insured/claimant within 24 hours of assignment
  • Interview or obtain recorded statements from the claimant, the Insured and any witnesses
  • Run ISO Claim search
  • Respond to Reservation of Rights letters from Excess Carrier if necessary
  • Negotiate with Attorneys
  • Generate release Pilot Catastrophe Pilot Catastrophe / Catastrophe Management

Desk Adjuster/Agent Advocate/Compliance Assistant

Pilot Catastrophe Services
10.2013 - 12.2014
  • Contact claimants to schedule appointments to inspect for catastrophe-related losses.
  • Electronically entered findings, and submitted documents and photos, to be reviewed for processing.
  • Provided courteous customer care.
  • Entered information on submitted claims to ensure the timely progression of claim determination and eligibility
  • Ensured that compliance standards were met for all claims.
  • Liaison for agents, adjusters, and insureds, providing information to ensure a timely claims process.
  • Contacted adjusters to advise them of outstanding invoices needing submission.
  • Assisted outside adjusters complete daily billing of outstanding invoices to be approved for payroll.
  • Generated reports to track problematic insurance claims.
  • Entered information on submitted claims to ensure the timely progression of claim determination and eligibility
  • Processed flood, wind, and hail-related homeowners' claims.
  • Ensured compliance standards were met for NFIP claims.
  • Negotiated settlements with the PA and attorney to bring the claim to a mutually agreeable resolution.
  • Provided the necessary documentation to the legal department for claims that could not be resolved pre-trial.

Education

Bachelor of Science - Business Administration And Management

Jackson State University
Jackson, MS
05-2009

General Studies

Vigor High School
Mobile, AL
05-2003

Skills

  • Liability, Property & casualty, Customer service, Claims handling, Property
  • Claims, Auto claims, Investigating, Litigating, Estimating, Business claims, Fire
  • Insurance, Hail and crop damage, Water & flood claims, Working with industry
  • Experts, Computer skills, Policy knowledge
  • Claims File Management Processes
  • Settlement Negotiations
  • Verbal and Written Communication
  • Policy Investigations
  • Complex Problem Solving
  • Coverage Determination
  • Litigation Management
  • Customer Service and Support
  • Claims Investigation
  • Policy investigations
  • Legal Compliance
  • Liability Analysis
  • Risk assessment
  • Fraud investigation
  • Risk mitigation strategies
  • Fraud detection

Timeline

Senior Property Claims Adjuster and Risk Manager

Liberty Mutual
01.2023 - Current

Liability Claims Adjuster

Allstate Insurance Co
01.2021 - 01.2023

Desk Adjuster/File Examiner/Mediation

PLS-UPC
12.2017 - 12.2020

Desk Adjuster/File Examiner/Condo Commercial

DMA Claims Services
12.2016 - 12.2017

Loss/Earthquake Desk Examiner

Pilot Catastrophe Services
12.2014 - 12.2016

Desk Adjuster/Agent Advocate/Compliance Assistant

Pilot Catastrophe Services
10.2013 - 12.2014

Bachelor of Science - Business Administration And Management

Jackson State University

General Studies

Vigor High School

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Calisha Marie Baker