Highly qualified, results-driven, detail-oriented individual with excellent communication and problem solving skills. Over 14 years of providing exemplary customer service, rapid learner who brings excitement and enthusiasm to my work and my team. Energetic and goal oriented professional with a well-rounded background in optimizing internal performance.
AS400; SRO; ACCLAIM; IAM; Microsoft Office Suite |
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- Establish coverage, determine liability and conclude each claim fairly and promptly.
- Immediately contacting claimants, insured customers, or lien holders to effectively investigate each claim from beginning to end.
- Relocating salvage in a timely fashion and investigating salvage value to negotiate settlement.
- Investigating coverage, cause, nature and extent of damage to assess loss value.
- Maintaining effective diaries.
- Evaluate and negotiate prompt, fair and equitable auto total loss settlements by contacting claimants, insured customers, or lien holders.
- Investigate and conclude fire & theft claims by effective negotiation and settlement of claims.
- Relocating salvage in a timely fashion and investigating salvage value to negotiate settlement.
- Supported Claim Handlers in multiple Lines of Business, involved in processing and/or issuing invoices, outside expenses, attorney expenses and centralized expense payments.
- Excellent customer service and communication skills.
- Preparing, generating and reviewing monthly, quarterly, annual, and ad hoc reports, documents and presentations using the most effective technology: Strong time management skills and ability to prioritize daily assignments.
- Daily reports for claim professionals from Claim Platform.
- Responsible for the management of legal reports and preparation and resolution of subpoenas.
- Completed Adjuster's Licensing Class for Adjuster's License Deployed and Part of the Emergency Response Team.
- Supported claims managers in processing hundreds of disability claims.
- Analyzed and determined completeness and validity of claims.
- Assisted policyholders in a busy call-center environment.
- Assist customers in applying for short/long term disability claims and FMLA Provide customers with exceptional customer service by problem solving and communicating ideas effectively. Register and research many multi-million dollar accounts accurately and effectively on a daily basis. Extensive knowledge of ICD-9 codes, medical terminology and Federal and State Regulations for disability claims. Communicate with employers to verify employee benefits'. Meet and exceed the quota for the amount of claims registered within my department. Developed a strong understanding of insurance policies and legal issues through completion of a series of INS classes coupled with in-depth, multi-week claims training.
- Analyze claims to determine extent of company's liability, set up policies in accordance to policy provisions.
- Collaborate with claims team, sales team, and implementation and interview claimants to correct errors, rectify omissions and investigate questionable issues.
- Completed more than 2,500 claims throughout tenure.
- Provided optimum service to policyholders and identified fraudulent claims.
- Research and identify ways to improve process efficiencies Selected by supervisor to assist with file closures; resolve complex claims-processing issues; participate in quality-control audits; and monitor claim status updates.
- Maintained a superior quality rating of 94% in file handling and claims resolution from 2009-2010, exceeding the 85% departmental goal.
- Received Cigna Champion Award (2010).
- Talked to patients about their medications and performed administrative work in the pharmaceutical field like the task to review prescriptions requested with doctor's offices.
- Ensure the release of correct medications given and the payments for the medicines delivered or taken out of the facility.
- Communicated directly with patients over the phone to assist them in the awareness of their medications and the management of their insurance claims.
Biology
accounting, administrative, AS400, CPHT, benefits, call-center, communication skills, Excellent customer service, ICD-9, insurance, inventory, legal, medical terminology, Access, Microsoft Excel, Outlook, Word, Power Point negotiation, policies, presentations, analysis, problem solving, processes, quality, quality-control, Research, sales, settlements, supervisor, time management
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School Attended
- University of Texas @ Arlington
Job Titles Held:
- Property Damage Adjuster
- Total Loss Adjuster
- Claims Operations Specialist
- Customer Service Associate
- Claims Analyst
- Pharmacy Technician
Degrees
- Bachelor of Science
- Completed Anatomy and Physiology classes and customer service delivery and accounting Claims Adjuster Licensed in TX, OK, LA.
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