Summary
Overview
Work History
Education
Skills
Watching CFL & NFL
Additional Information
Timeline
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Michele Foxall

Edmonton,AB

Summary

Organized and detail-oriented Investigator dedicated to improving efficiency, productivity, and profitability through continuous process improvement. Analytical thinker, skilled at developing innovative solutions to complex problems. Service-oriented Claims Adjuster and skilled at applying creative approaches to solving complex problems. Adept at developing profitable and quality-focused processes. Detail-oriented Examiner with 22 years of experience. Strong command of conflict resolution and negotiation combined with excellent reporting and research skills. Thorough understanding of claims process and multi-line of claims. Claims Adjuster with deep experience in confidential litigation claims. Superbly positioned to investigate, evaluate, and settle multiline claims. Excellent abilities to decipher fraudulent activities, analyze data, confer with legal counsel, and communicate with Crown Prosecutors to gain details for processing claims. Motivated Claims Adjuster specializing in auto, property, and general liability and recoveries Negotiates peaceful resolutions of all claims with emphasis on fairness and thoroughness. Trustworthy and dependable. Detailed Adjuster with 1 8 years of experience in corporate insurance claims. Strong command of claimant information intake processes, records documentation, and fraudulent investigation protocols. Impactful skills in preparing operational reports, presenting information to audiences, and approving claim payouts. Organized and dependable candidate successful at managing multiple priorities with a positive attitude. Willingness to take on added responsibilities to meet team goals. A hardworking and passionate job seeker with strong organizational skills eager to secure an entry-level position. Ready to help the team achieve company goals. Organized and detail-oriented Investigator dedicated to improving efficiency, productivity, and profitability through continuous process improvement. Analytical thinker skilled at developing innovative solutions to complex problems.

Overview

21
21
years of professional experience

Work History

Claims Adjuster

The City Of Edmonton
06.2005 - Current
  • theImproved claim resolution times by efficiently managing a caseload of 50+ claims per month. With a pending over 200 files per month
  • Achieved high customer satisfaction ratings by providing clear and timely communication throughout the claims process.
  • Negotiated favorable settlements with claimants, attorneys, and other insurance carriers to minimize financial risk for the company.
  • Conducted thorough investigations of complex insurance claims, gathering evidence and analyzing relevant documentation.
  • Collaborated with legal teams to defend against fraudulent claims, saving company resources and maintaining its reputation.
  • Identified potential fraud indicators early in the investigation process, protecting company assets from potential losses due to fraudulent activity.
  • Reduced processing time for property damage claims by accurately assessing repair costs and negotiating with contractors.
  • Contributed to a positive work environment through active participation in team meetings and collaborating on cross-functional projects.
  • Examined claims forms and other records to determine insurance coverage.
  • Prepared summaries of damage, payments, and policy coverage.
  • Documented all investigation activity and presented reports to management.
  • Substantiated legitimate claims and denied unjustified claims.
  • Conducted day-to-day administrative tasks to maintain information files and process paperwork.Identified suspicious losses and contacted the manager for investigative assistance.
  • Collected recovery and Litigation information from customers to complete claims and legal files.
  • Collected evidence to support contested claims in court.
  • Established productive working relationships with public officials and law enforcement officers.
  • Testified on behalf of the City of Edmonton as part of criminal and civic proceedings.
  • Prepared Litigation and cost documents for managers and Crown Prosecutors legal personnel.
  • Reviewed and analyzed suspicious and potentially fraudulent insurance claims.
  • Evaluated original investigation reports and documents to resolve secondary concerns.
  • Researched claims and incident information to deliver solutions and resolve problems.
  • Analyzed information gathered by investigation and reported findings and recommendations.
  • Reviewed police reports, medical treatment records, and physical property damage to determine the extent of liability.
  • Assisted in updating training materials for new hires based on evolving industry standards and best practices.
  • Developed strong relationships with repair vendors, ensuring quality service and fair pricing for clients in need of repairs after an incident.
  • Mentored junior adjusters on best practices and industry regulations, contributing to their professional growth and development.
  • Evaluated coverage accurately by interpreting complex insurance policies and applying them to specific claim scenarios.
  • Organized, planned, and documented materials for Crown Prosecutor claims.
  • Analyzed information gathered by investigation and reported findings and recommendations.
  • Followed up on potentially fraudulent claims initiated by claims representatives.

Claims Adjuster

Intact Insurance
11.2002 - 06.2005
  • Conducted thorough investigations of complex insurance claims, gathering evidence and analyzing relevant documentation.
  • Developed strong relationships with repair vendors, ensuring quality service and fair pricing for clients in need of repairs after an incident.
  • Maintained compliance with state regulatory requirements through meticulous documentation and adherence to company policies.
  • Provided exceptional customer service during emotionally difficult situations for policyholders following accidents or natural disasters.
  • Contributed to a positive work environment through active participation in team meetings and collaborating on cross-functional projects.
  • Examined claims forms and other records to determine insurance coverage.
  • Reviewed police reports, medical treatment records, and physical property damage to determine extent of liability.
  • Identified suspicious losses and contacted manager for investigative assistance.
  • Followed up with insured individuals regarding premium and deductibles payments.
  • Handled [Type] calls from customers and other stakeholders about [Type] processes.
  • Corrected [Type] codes to properly classify [Type] claims.

Education

CIP -

Insurance Institute
Edmonton, AB

Skills

  • Accident Scene Investigations
  • Legal Proceedings Knowledge
  • Insurance Policy Coverage Knowledge
  • Property Loss
  • Claims Processing
  • Risk Management
  • Coverage Assessments
  • Policy Interpretation
  • Claims Investigation
  • Decision Making
  • Damage Assessment
  • Process Improvement
  • Problem-Solving
  • Empathy and Compassion
  • Analytical Thinking
  • Professionalism
  • Fraud Detection
  • Liability Determination
  • Settlement Negotiations
  • Coaching and Mentoring
  • Settlement Negotiation
  • Decision-Making
  • Coverage Assessment
  • Team Collaboration

Watching CFL & NFL

need more information

Additional Information

I am starting to explore and learn about my Indigenous heritage.

Timeline

Claims Adjuster

The City Of Edmonton
06.2005 - Current

Claims Adjuster

Intact Insurance
11.2002 - 06.2005

CIP -

Insurance Institute

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Michele Foxall