pip mpc claims specialist resume example with 12+ years of experience
JessicaClaire
Montgomery Street, San Francisco, CA94105609 Johnson Ave., 49204, Tulsa, OK
Home: (555) 432-1000
Cell:
resumesample@example.com
:
Summary
Licensed claim adjuster bringing eight years in the field of insurance with an emphasis on automobile claims. Energetic, and motivated to succeed in a fast-pace and deadline-driven professional environment.
Highlights
Handle an average of 275 files.
Comprehensive knowledge of PIP/MPC regulations for four states, including New York.
Self-directed
Analytical Interviewing techniques
Knowledge of Mitchell Billing
Legal Exchange
American Arbitration Forum
Microsoft Office/Word 2013
Strong interpersonal and communication skills
Experience
PIP/MPC Claims Specialist, 06/2014 to Current Plymouth Rock – Amherst, MA,
Process Medical Payment Coverage (MPC), Personal Injury Protection (PIP),and Medical Claims Management: Confirm insured facts, update parties to the loss information.
The ability to obtain relevant evidence and information to identify suspicious claims, and either handle or escalate appropriately.
Explain relevant coverage, pay claims within authority granted, and within that state's regulations.
Pay adjustment expenses up to the granted authority level.
Obtain necessary Independent Medical Examinations (IMEs) or Utilization Reviews (URs) as the ongoing medical management may require.
Review Litigation files, prepare recommendations to the Team Manager. Prepare correspondence to Defense Counsel, review pleadings, complaints, discovery responses, and motions, all within the necessary time frame.Implement a negotiation strategy to settle litigation on a case by case basis.
80% success rate in defending litigation.
Auto Claims Representative, 02/2010 to 06/2014 State Farm Insurance – City, STATE,
Reduced loss ratios through fair and prompt processing of claims.
Analyzed first reports of loss and underlying file material to determine if a claim was suspect.
Secured recorded statements from all necessary parties.
Obtained all physical evidence available to approve or deny coverage.
Underwriting Service Assistant, 2009 to 02/2010 State Farm – City, STATE,
Processed corrections, endorsements and cancellations.
Implemented and monitored new underwriting guidelines for the company.
Education
: Criminal Justice- attended 1983-1984, Expected in to Northern Essex Community College - Haverhill, MA GPA:
: Nursing- attended 1992-1995, Expected in to Adirondack Community College - Queensbury, NY GPA:
Associate in Claims Designation: , Expected in 2014 to The Institutes - , GPA:
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