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claims examiner resume example with 20+ years of experience

Jessica Claire
  • , , 609 Johnson Ave., 49204, Tulsa, OK 100 Montgomery St. 10th Floor
  • Home: (555) 432-1000
  • Cell:
  • resumesample@example.com
  • :
Professional Summary

SPECIAL EVENTS MANAGER Outstanding special events leader able to impact top organizations by delivering high quality, inventive and unique events through project management, public relations, relationship cultivation, and nonprofit development. Leverage core strengths to increase organization exposure and maximize visibility. Well connected to network of community leaders and media outlets that enable achievement of group’s mission and goals. Long-standing community volunteer with passion for improving status quo. VENDOR RELATIONS CONTRACT NEGOTIATION TEAM LEADERSHIP COMMUNICATIONS MENTORING PROCESS STREAMLINING CUSTOMER RELATIONS FUNDRAISING LOGISTICS COST CONTAINMENT ORGANIZATION BUDGET / RESOURCE ADMINISTRATION PROPOSAL CREATION AND DEVELOPMENT PREPLANNING / ONSITE MANAGEMENT President (concurrent with employment) Founded event planning organization whose mission is to empower Detroit-area youth, women, and the LGBT community by providing educational and inspirational resources and events. Directed and executed overall management, production, and growth of special events company. Strategized and coordinated all aspects of fundraising and community visibility events, including developing and managing budgets, soliciting donations, negotiating vendor contracts and securing high-profile speakers. Partnered with community organizations and maintained positive relationships with venue and logistics providers. Conceptualized, produced, and implemented annual event “The Pink Ice Breaker”; expanded venue and nearly doubled event attendance in second year. Recruited renowned writers, Grammy Award Nominee, and radio personality to generate event visibility and increase participation. Recognized on Detroit Radio and in local LBGTQ news magazine, Between the Lines for implementing events that increased community awareness of domestic violence and sexual assault.

Skills
  • CCC Pathways Appraisal Quality Solution
  • Magnify Predictive Targeting System
  • Fair Isaac Claims Advisor
  • AMS360
  • Automated Work Distributor (AWD)
  • Microsoft Office Suite
  • Policy investigations
  • Valuation knowledge
  • Coverage determination
  • Insurance policy coverage knowledge
  • Legal proceedings knowledge
  • Healthcare Common Procedures Coding System (HCPCS)
  • Benefits review
  • Microsoft Publisher
  • Claims
  • Microsoft Word
Work History
Claims Examiner, 01/2017 to Current
Apex SystemsFramingham, MA,
  • Analyzes, evaluates, and calculates benefit payments for simple life and accidental injury claims within scope of authority and experience level in accordance with established departmental and statutory guidelines
  • Has authority to approve claims up to a specified limit and referral claims staff will review claims in excess of prescribed limits and authority Provides guidance and support regarding questions on claim files to less tenured team members; also assist with projects and performs other duties as assigned
  • Calculate benefits, including statutory interest, for simple non-contestable life and accidental injury claims
  • Communicates with members, beneficiaries, and legal representatives to appropriately adjudicate life insurance claims.
Claims Adjudicator, 01/1997 to 01/2016
Exela Technologies Inc.Livonia, MI,
  • Promoted six times to highest level claims examiner with the key function of special claims processing
  • Served as first-point-of-contact and liaison for two high dollar at-risk groups whose medical claims required specialized skills
  • Worked with medical practice group liaison to identify problems and together implemented steps to expedite process
  • Decreased group complaints and turnaround time drastically
  • Implemented ten processing workarounds with group account liaison in five years to ensure timely processing in spite of system malfunctions
  • Trained several leaders and employees on steps and procedures for processing both group claims
  • Point-person for company-wide events, fundraisers, and volunteer activities.
Vice President, 01/2001 to 01/2012
Jones Lange Lasalle Inc.Overland Park, KS,
  • SELECTED EVENTS FOR: BLACK PRIDE SOCIETY; S.A.S.H.A CENTER; PINK ICE PROMOTIONS; BLUE CROSS BLUE SHIELD
  • DETROIT INTERIM HOUSE FUNDRAISER
  • ALZHEIMER’S WALK
  • WOMEN’S HEALTH FAIR
  • DETROIT THAW WALK
  • LITERACY EVENT FOR FEMALE HIV AWARENESS
  • BREAST CANCER WALK
  • DOMESTIC VIOLENCE AWARENESS
  • AIDS WALK DETROIT
  • ARTS BEATS AND EATS
  • CROHN’S AND COLITIS FOUNDATION
  • SPECIAL EVENTS MANAGEMENT EXPERIENCE “During my affiliation with Kimberly Claire over several years, she has demonstrated an excellence for envisioning, creating, planning and producing well attended quality events that appeal and draw diverse groups of people.” -Hank Millbourne, LMSW, MA, M DIv, Former President, Black Pride Society, Nonprofit organization that serves as a social barometer for community development while partnering with state, local, and national organizations to advocate for equality and social justice
  • Created and executed strategic planning, operational policies and procedures, staff supervision, sponsor recruitment, cultivation and retention, and event contract negotiation
  • Served as primary media spokesperson and liaison between organization and community resources
  • Collaborated with board to develop and implement events, and provide leadership guidance
  • Managed all administrative logistics
  • Increased attendance for women’s event by three times the average after first year and from 10% to 50% participation over five years
  • Created strategic marketing plan for “Street Team” to improve program visibility to surrounding locations doubling participant involvement
  • Expanded network of artists across country that increased brand recognition and attracted over half a million guests, performers, sponsors, and vendors; retained 99% of sponsors and increased sponsorship by 20%
  • Launched first-time ever political forum for all six Detroit mayoral candidates at a private home venue
  • Propelled organization as leader of three key city events and cultivated new sponsorship for an ongoing film festival, artist showcase, and a brunch
  • Achieved rating in walking marathon across country as “top spot” by partnering with restaurant in health education venture and sponsorship
  • Joined community supporter to plan a fundraising program as part of a larger event that eventually became a core weekend event.
Education
BA: Business Management, Expected in to Concordia University System - ,
GPA:
H&R Block Income Tax Course: , Expected in to - Detroit, MI
GPA:
This course provides a foundation of tax knowledge for individuals interested in becoming H&R Block Tax Professionals.

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Resume Overview

School Attended

  • Concordia University System

Job Titles Held:

  • Claims Examiner
  • Claims Adjudicator
  • Vice President

Degrees

  • BA
  • H&R Block Income Tax Course

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