Krishona S.

Experience

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  State Farm Insurance

  Jun 1999 - Jul 2004

  Auto Liability Claims Adjuster

  • Investigated, evaluated, negotiated, and settled losses involving vehicles and personal injuries to people. • I fully explored all issues surrounding a loss and made a determination of payment based on the policy contract.Experience:• Auto Field Adjuster 1999-2001• Bodily Injury Claims Adjuster 2001-2003• Total Loss Adjuster 2003-2004

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  Rent-A-Center

  Jul 2004 - Jun 2005

  Risk Management Coordinator

  • Monitored the daily activities of our third-party administrator, review high-exposure auto and general liability claims, produced weekly and monthly reports and loss runs. • Processed incoming lawsuits, attorney letters of representation and store losses. • Conducted quarterly on-site file reviews and audits of all auto and general liability claims, and adjusted property damage claims in house. Experience:• Risk Specialist 2004-2005• Managed a policy limit reserve of up to $2 million Show less

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  AIG

  Jun 2005 - Oct 2008

  Auto/Casualty Claims Adjuster

  • Handled personal lines claims generally involving automobile property damage and small bodily injury.• Exercised discretion in evaluating coverage and liability investigation, negotiation and settlement of claims up to established authority. • Requested outside investigation from independent vendors, as required and evaluated credibility of witnesses to determine liability.Experience:• Auto Handler 2005-2006• Extended Bodily Injury Handler 2006-2008• Case load of 170-200• Managed a policy limit reserve of up to $100,000 Show less

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  MetLife

  Nov 2008 - Oct 2013

  Casualty Claims Adjuster

  • Interviewed insureds, claimants and other parties to determine facts of the claim and severity of injuries. • Documented claim files to comply with the regulations and guidelines. • Processed mild to severe casualty, uninsured and underinsured claims in five states (Texas, Louisiana, Oklahoma, New Mexico and Arkansas). • Determined value of the injury claim, negotiated and committed to the settlements and moved claims to closure. • Resolved complaints and participated in arbitration procedures. • Recommended subrogation and Special Investigation Unit referrals.Experience:• Auto Investigation Unit 2008-2010• Casualty Unit 2010-2013• Represented MetLife as an Arbitrator for Arbitration Forums• Case load of 130-150• Managed a policy limit reserve of up to $300,000 Show less

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  Sedgwick

  Nov 2013 - Sept 2015

  Senior Claims Examiner

  • Analyzes and manages high-exposure commercial school bus and transit transportation by investigating and gathering information to determine the exposure on the claim. • Manages claims through well-developed action plans to an appropriate and timely resolution. • Assesses liability and resolves claims within evaluation. • Calculates and assign reserves to claims, manages reserve adequacy throughout the life of the claim. • Negotiates settlement of claims, pay benefits due, approve and makes timely claim payments and adjustments within designated authority level. • Prepares necessary state fillings within statutory limits. • Manage litigated files through the litigation process, ensures timely and cost effective claims resolution. • Coordinates vendor referrals for additional investigation and/or litigation management. • Manages claim recoveries, including but not limited to subrogation, Second Injury Fund excess recoveries and Social Security and Medicare offsets. • Communicates claim activity and processing with the claimant and the client and maintain professional client relationships. Experience:• Currently licensed and handle claims in 28 states including New York• Case load of 150-180 features• Manage a policy limit reserve of up to $5 million• Handle 70% Litigated files Show less

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  Innovative Risk Management

  Jul 2015 - Sept 2016

  Litigation Specialist

  • Handles Commercial Trucking, Construction and General Liability claims. Assigns defense counsel, sets initial reserves, and monitors reserves for adequacy throughout life of claim.• Attends scheduled mediation and arbitration.• Controls adjusting expense costs on assigned claim files. • Approves the use of experts and other defense specialists and activities in the defense of the claim file. • Develops regulatory reporting notices as required on assigned claims. • Evaluates claims for coverage via the insured programs.• Evaluates significance of incidents, claims and suits in order to determine strategy for resolution. • Identifies trends through the claims review process and makes recommendations regarding future activity and corrective action. • Interacts with claimants and plaintiff's counsel in response to inquiries. • Makes recommendation to committee(s) and senior management for claim adjudication and settlement authority. • Monitors claims activity through continued interaction with interdepartmental team members. • Negotiates settlements on assigned claims and suits subject to program authority guidelines. • Participates in annual evaluation and audit of defense panel. • Prepares and presents case reviews to committee(s) and senior management. • Prepares quarterly reports on active file settlement negotiations, current activity on significant claim files, reserve changes, and file expenses. Experience:• Currently licensed and handle claims in 28 states including New York• Case load of 80-100• Manage a policy limit reserve of up to $5 million with additional excess coverage• Handle 90% Litigated files Show less

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  Gallagher Bassett

  Feb 2017 - Mar 2018

  Senior Resolution Manager

  • Handles Commercial Auto, Trucking and General Liability by investigating and gathering information to determine the exposure on the claim. • On National dedicated account handling claims involving oil & gas, electric, and infrastructure. • Negotiates settlements on assigned claims and suits subject to program authority guidelines. • Prepares and presents case reviews to committee(s) and senior management. • Prepares quarterly reports on active file settlement negotiations, current activity on significant claim files, reserve changes, and file expenses. • Processes claims consistent with clients' and corporate policies, procedures and "best practices" and also in accordance with any statutory, regulatory and ethics requirements.Experience:• Currently licensed and handle claims in 28 states including New York • Case load of 150-200• Manage a policy limit reserve of up to $1 million with additional excess coverage• Handles 80% Litigated files Show less

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  AmTrust Financial Services, Inc.

  Apr 2018 - Sept 2018

  Senior Commercial Claims Adjuster

  • Maintains appropriate financial accountabilities (reserving) and controls loss adjustment expenses• Litigation claims with minimal direction to handle Commercial Auto and General Liability claims of moderate-to-high exposure and complexity.• Makes timely and appropriate contacts with interested parties, including, but not limited to the insured, claimant/attorney, witnesses and producers. • Determines, reviews and analyzes coverages that may or may not apply to the claim; Plans, executes and reviews investigations-coverage, liability and/or damages – including the securing of a signed or recorded statement of the insured, claimant and/or witnesses. • Discusses possible coverage issues with supervisor and drafts coverage positions as applicable. Obtains medical records and reports; police ambulance and agency reports; photographs and measurements; and, expert assistance/testimony.• Applies facts, as determined by contacts and investigation, to the laws of a Multi-State jurisdiction to properly evaluate exposure. • Establishes indemnity and expense reserves as the claim transpires. • Controls and manages claims-related expenses; determines and executes plans of action to resolution, including the avoidance/minimization of litigation.• Works with and actively monitors and manages defense counsel. • Minimizes losses through identification of subrogation and prompt disposition.• Identifies issues (coverage, liability, damages, handling), seeks appropriate guidance, and communicates pursuant to authority structure. • Determines and fulfills reporting requirements to supervisor/manager, Home Office, SIU, client companies and reinsurers.Experience:• Currently licensed and handle claims in 28 states including New York • Case load of 100-140• Manage a policy limit reserve of up to $1 million with additional excess coverage• Handles 80% Litigated files Show less

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  Sedgwick

  Dec 2021 - now

  Senior Claims Examiner III

  · Analyzes and processes general liability and complex claims by limited investigating and gathering information to determine the exposure on the claim; manages claims through well-developed action plans to an appropriate and timely resolution.· Communicates claim activity and processing with the client; maintains professional client relationships.· Ensures claim files are properly documented and claims coding is correct.· Negotiates claim settlement up to designated authority level.· Identifies and investigates for possible fraud, subrogation, contribution, recovery, and case management opportunities to reduce total claim cost.· Coordinates legal defense by assigning attorney, coordinating support for investigation, and reviewing attorney invoices, monitors counsel for compliance with client guidelines.· Delivers compassionate service that fast, and easy, to ensure customer retention while verifying coverage,· Represents Company in depositions, mediations, and trial monitoring as needed. Show less