Kimberly Hines

Results-driven risk, claims, and operations professional with experience managing multi-jurisdictional workers' compensation claims across Massachusetts, Rhode Island, Delaware, Pennsylvania, and Connecticut, with additional licensing in Vermont and Maine. Skilled in investigation, risk and exposure evaluation, regulatory compliance, negotiation, inventory management, stakeholder communication, and operational execution. Recognized as the #1 team performer in claim closings for three consecutive months and as one of the highest users/adopters of AI tools office-wide.

Brings additional experience in business operations, performance analysis, cross-functional collaboration, process optimization, and technology-enabled workflow improvement.

Workers' Compensation Claims Representative - Travelers Insurance

(2024-08)

• Manage workers' compensation claims across MA, RI, DE, PA, and CT, applying state-specific requirements while coordinating claim strategy, investigation, evaluation, and resolution.
• Evaluate compensability, exposure, claim facts, medical and wage information, and other relevant documentation to support timely and appropriate claim decisions.
• Manage competing priorities across a multi-state inventory, maintaining focus on resolution, regulatory requirements, customer communication, and claim progression.
• Ranked #1 on the team in claim closings for three consecutive months, demonstrating strong inventory management, prioritization, and execution.
• Communicate with injured workers, employers, medical providers, attorneys, and internal partners to gather information, resolve issues, and advance claims.
• Recognized as one of the highest users/adopters of AI tools office-wide; use generative AI and automation tools to support productivity, research, workflow efficiency, and day-to-day operations.
• Use Excel, Power Automate, Outlook, ISO Claims Search, ChatGPT, Claude, and internal claim systems to research, organize, automate, and execute work.

Claim Operations Specialist - Travelers Insurance

(2023-02 - 2024-08)

• Partnered with claim professionals across Workers' Compensation, Auto, Property, and General Liability to support timely claim resolution and customer service.
• Prepared operational reports for claim professionals and unit managers and supported financial controls through reporting, transaction processing, and communication of findings.
• Managed business information, financial transactions, legal and medical documentation, and customer inquiries in a high-volume claim environment.
• Coordinated with multiple departments and stakeholders to resolve discrepancies, maintain accurate records, and support operational standards.

E-Commerce / Catalog Merchandising Coordinator - Specialty Commerce Corporation

(2017-04 - 2019-07)

• Managed and optimized product listings across dropship sales channels, monitoring product performance, rankings, ratings, customer reviews, and conversion opportunities.
• Collaborated with executives, Marketing, and Sales to develop and execute sales optimization strategies and improve customer experience.
• Linked sales-channel products to inventory systems, monitored website and catalog accuracy, and coordinated cross-functional project timelines.
• Led recurring team meetings to communicate project updates, timelines, priorities, and relevant operational activities.

Auto Physical Damage Claim Representative Trainee - Travelers Insurance

(2016-04 - 2016-12)

• Handled claims throughout the life cycle, including customer contact, coverage review, investigation, evaluation, reserving, negotiation, and resolution.
• Analyzed policy terms, conditions, exclusions, endorsements, jurisdictional issues, causation, damages, liability, contribution potential, and exposure.
• Maintained compliance with internal quality standards and state-specific regulations while managing an inventory of claims.
• Established and adjusted reserves and negotiated settlement amounts within assigned authority.

Operations Specialist - Travelers Insurance

(2015-05 - 2016-04)

• Provided operational support across Auto, Workers' Compensation, and Property claims, including client requests, correspondence, medical bills, litigation documents, and claim setup.
• Researched and resolved file discrepancies, coordinated benefit information, and maintained accurate claim documentation.

Operational Support Specialist - MassMutual Financial Group

(2013-07 - 2015-05)

• Performed operational research, auditing, reporting, records management, data retrieval, and complex internal and external service requests.
• Processed and tracked client transactions and documentation while following departmental procedures and service standards.

B.A. - Psychology - Boston College (2012)