Ruth Appia
Tampa,FL
Summary
Accomplished Claims Professional with a proven track record of excellence in casualty auto claims adjusting. Demonstrated expertise in assessing and resolving moderately complex first-party and third-party injury claims with a focus on accuracy, compliance, and customer satisfaction. Skilled communicator with a strategic mindset and a strong ability to navigate high-stakes negotiations and mitigate claim risk effectively. Recognized for driving successful outcomes, fostering client trust, and delivering superior results in casualty auto claims management.
Overview
21
21
years of professional experience
Work History
Casualty Claims Adjuster
USAA (United Services Automobile Association),m
Riverview, Florida
02.2017 - 07.2024
- Conducted investigation of 15-20 new auto claims weekly. Included activities such as securing recorded statements of Insured’s, injured parties, claimants and witnesses. Collected evidence and appropriately documented the claims file.
- Analyzed evidence, confirmed liability, and compensation of damages as appropriate.
- Assessed policy for submitted claims, notified insured’s, claimants, and Adverse Carriers of any issues. Determined and established reserves, adjusting reserves as necessary during the life of the claim.
- Engaged Independent Adjusters, Independent Medical Examiners or Special Investigations Units as necessary. Set appropriate method’s of inspection, and rentals, using best practices.
- Assessed actual damage associated with claim for both property damage and bodily injury. Conducted negotiations for bodily injury, within assigned authority limits to settle claims.
- Coordinated litigation activity associated with assigned clams. Worked with Litigation Team on value and/or liability disputes. Articulated decisions and policy issues to litigation, staff counsel and management via Impasse, to ensure a timely and cost-effective resolution.
- Key Achievements:
- Consistently met / exceeded early-settlement goals of 30% of new losses, per month, on third-party injury claims. Conducted negotiations with non-attorney represented claimants to achieve the goals.
- Selected by the Director of the department to share best practices across the teams. Ultimately increased early settlement of bodily injury claims by 45% across all teams quarterly.
First Party Injury Adjuster - Florida PiP
USAA (United Services Automobile Association)
Tampa, FL
02.2015 - 02.2017
- Handled 25-30 first party medical claims weekly, within Florida. Reviewed USAA Members policies for applicable Personal Injury Protection or Medical Payments coverage.
- Set appropriate reserves as determined through investigation of confirmed injuries.
- Proficient with Auto Injury Solutions (AIS) / MBA databases. Reviewed 400-500 EOR’s weekly, ensuring compliance with medical procedure codes and audit requirements for provider payments.
- Paid 400-500 medical bills per week within coverage limits for members.
- Ensured correct audits and compliance with policies and regulations.
- Scheduled Independent Medical Examinations (IMEs) as needed to deter fraud. Referred potential fraudulent claims to Special Investigations Units.
- Key Achievements:
- Settled Pre-Suit Demands in a timely manner, potentially saving USAA nine million dollars in one year, on interest, penalties and further litigation.
- Designated team champion for Auto Injury Solutions (AIS) / Medical Bill Audit (MBA) Program; Served as team subject-matter expert.
Auto Liability Adjuster III
USAA (United Services Automobile Association)
Tampa, Florida
11.2008 - 02.2015
- Investigated, reviewed, evaluated, negotiated and adjusted 25-30 auto claims weekly from first notice to settlement and close. Determined liability, reserves and compensation.
- Expert use of ISO ClaimSearch and LexisNexis.
- Set appropriate appraisals and rentals. Solicited the assistance of Field Physical Damage Appraisers for questionable damages.
- Exceeded audit goals for accuracy, quality of file documentation, legal / contractual compliance and timely closing of claims. Maintained closing ratio of 93-100% per month. Ensured timely closing of dangling reserves.
- Increased individual and team referrals by 70% per month. Created and shared referral strategy (“Deepening Suggestions” scripts and tips) with 12 team members. Referrals grew consistently through weekly team meetings. Designated Referral Team Champion after only six months.
- Chosen for several key training positions including High Performance and PTO Assist Team (2014). Introductory Non-Injury Adjuster Training (INAT) Program (2015) and Claims Intern Mentor (summer 2015).
- Key Initiatives:
- Collaborated with senior management to reduce a total of 75,000 high pending reserves in the MST via the use of VPN OT over the course of 3 weeks.
- Served on a team of 15 to eliminate workload surge, closing 20,000 identified exposures in a single weekend.
Customer Service Representative
Progressive Insurance
Riverview, FL
11.2003 - 11.2008
- Provided customer service for automobile insurance through inbound calls. Responded to 25+ calls per shift. Evaluated client policies and identified insurance needs.•
- Earned Florida 440 Insurance License.
Education
MBA - Business Administration And Management
Saint Leo University
Saint Leo, FL12-2015
620 Property & Casualty (all Lines) - Insurance
State of Florida Licensure
Tampa, Florida11-2008
SCLA Designation - Insurance And Risk Management
American Educational Institute (AEI)
Tampa, FloridaSkills
- Investigate and evaluate claims
- Interpret policies and analyze coverage
- Assess and estimate damages and values
- Follow legal and regulatory guidelines
- Analyze medical records
- Resolve claims disputes and appeals
Languages
English
Native language
Spanish
Upper Intermediate (B2)
B2
Timeline
Casualty Claims Adjuster
USAA (United Services Automobile Association),m
02.2017 - 07.2024
First Party Injury Adjuster - Florida PiP
USAA (United Services Automobile Association)
02.2015 - 02.2017
Auto Liability Adjuster III
USAA (United Services Automobile Association)
11.2008 - 02.2015
Customer Service Representative
Progressive Insurance
11.2003 - 11.2008
MBA - Business Administration And Management
Saint Leo University
620 Property & Casualty (all Lines) - Insurance
State of Florida Licensure
SCLA Designation - Insurance And Risk Management
American Educational Institute (AEI)
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