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bodily injury claims associate resume example with 8 years of experience

Jessica Claire
  • Montgomery Street, San Francisco, CA 94105 609 Johnson Ave., 49204, Tulsa, OK
  • H: (555) 432-1000
  • C:
  • resumesample@example.com
  • Date of Birth:
  • India:
  • :
  • single:
  • :
Summary
Highly motivated Sales Associate with extensive customer service and sales experience. Outgoing sales professional with track record of driving increased sales, improving buying experience and elevating company profile with target market.
Skills
  • Proficient knowledge of medical terminology
  • Qualitative and quantitative data analysis
  • Project management
  • Research analytics
  • Data integration
  • Strong interpersonal communicator
  • Active listening
  • Multi-disciplinary collaboration
  • Executive leadership support
  • Client support optimization
  • Business to Business (B2B) operations
  • Organizational leadership
Experience
Bodily Injury Claims Associate, 04/2018 - Current
State Farm Insurance City, STATE,

Software Competencies: Mitchell Technology, 3PET (Third Party Evaluation Tool), ECS(Electronic Claims Services)

  • Examined claims data, investigate the facts, determine liability and adjust claims of a serious and complex nature within the limit of authority
  • Established an investigative plan; initiated investigation by gathering facts and evidence with all interested parties; completed appropriate reports; took recorded statements when necessary; and reviewed loss reserves and adjust or opens hidden exposures as necessary
  • Complied with confidentiality regulations in handling customer information through competent application of insurance contracts and endorsements, state laws and regulations, customer service philosophy, automotive repair method and parts, medical and anatomical terminology,
  • Verified claimants proper insurance coverage prior to procedures or appointment scheduling, reviewed medical bills for accuracy by utilizing Medical bill research to properly add diagnosis and CPT coding to medical bills for processing.
Claims Generalist, 05/2021 - 10/2021
Progressive Insurance City, STATE,

Software Competencies: NICE (Neptune Intelligence Computer Engineering) recording system, Accurint, Lexis Nexis

  • Provide quality customer service (30 customer daily) to assigned, insured when determining liability and assisting claimants throughout claims process to deliver timely service to customers.
  • Retain strong medical terminology understanding in effort to better comprehend procedures when consulting with field support teams, claim manager and other entities to receive support specific to assigned claim.
  • Collaborate with field support team, including quality control, team lead and adjusters to deliver support specific to claim assignment.
  • Compose modification to policies, transcribed business correspondences for supervisors, managers and other professionals to be communicated to external parties.
PIP/MPC Claims Associate, 07/2016 - 04/2018
State Farm Insurance City, STATE,
  • Processed medical claims by integrating Medical Payment Coverage (MPC) and Medical Claims with UB04 and CMS 1500 data into authorized billing format.
  • Developed organization system/repository for medical records in files, to ensure validity of treatment dates.
  • Obtained medical records, using a medical authorization.
  • Managed the communication of Explanation of Reviews (EORs), various patterns dictations, treatment prioritization/scheduling, to medical providers and insurance carriers.
  • Researched and reviewed information to determine validity of insurance claims and contacted companies and customers about decisions.
Licensed Quote & Bind Representative, 02/2014 - 07/2016
State Farm Insurance City, STATE,
  • Prepared cost analyses, tracked change orders and managed schedules to improve project performance.
  • Leveraged sales techniques and articulated product values to generate new business.
  • Collected data and information from vendors, sub-contractors and teammates to determine exact costs for all aspects of each project.
  • Developed bid proposals with itemized costs for clients to review and approve before beginning work on projects.
Education and Training
Bachelor of Science: Chemistry, Expected in 12/2009
-
Elizabeth City State University - Elizabeth City, NC,
GPA:
Status -

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Resume Overview

School Attended

  • Elizabeth City State University

Job Titles Held:

  • Bodily Injury Claims Associate
  • Claims Generalist
  • PIP/MPC Claims Associate
  • Licensed Quote & Bind Representative

Degrees

  • Bachelor of Science

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