Post Job Free

Resume

Sign in

Customer Service Medical

Location:
Dallas, TX
Posted:
July 21, 2016

Contact this candidate

Resume:

EARNEST WADE

***** ******* **** **. ******, Texas 77373

832-***-**** acvs6m@r.postjobfree.com

OBJECTIVE

Dynamic and efficient with extensive experience in customer-driven and dynamic industries also recognized success in customer service functions, providing support with proven ability to work effectively with positive results. Highly motivated and efficient with a valuable track record in achieving organizational goals with proven ability to thrive in busy environment. Excellent analytical skills with keen attention to detail, ability to analyze situations, research information to develop sound and ethical solutions. Innovative individual with proven ability to achieve organizational goals while displaying effective multi-tasking and management skills. Proactive and results oriented with excellent interpersonal communication skills and experienced in working with different teams and individuals at all levels from diverse cultural or socio-economic backgrounds.

Core Competencies

Organizational Leadership Risk Management Customer Service Organization Skills Client Relationship

Needs Assessment Policy & Procedure Compliance Strategic Planning & Implementation PROFESSIONAL EXPERIENCE

Allstate Insurance

06/2015- Current

AUTO THEFT ADJUSTER- Total Loss

Investigates and properly resolves personal lines material/physical damage Total Loss or Fire & Theft claims via telephone . Promotes and provides "Good Hands"customer service. Responsible for the handling of claims in accordance with prescribed authorizations and claims best practices. Promptly and effectively handles to conclusion all assigned claims with moderate direction and oversight. Makes decisions within delegated authority as outlined in company policies and procedures. Adheres to high standards of professional conduct consistent with the delivery of superior service. Initiates and conducts follow-ups via proficient use of claims systems and related business systems.Verifies proper policy coverages and applies where necessary applies best claims practices to conclude assigned material/physical damage claims cases in accordance with company guidelines.Opens, closes and adjusts reserves in accordance with company practices designed to ensure reserve adequacy. Recommends Special Reserves where necessary. Establishes and authorizes reserves and claims payments within the delegated authority.Partners with SIU and Subrogation to identify fraud and subrogation opportunities.Maintains and develops current knowledge of: assigned insurance lines; court decisions which may impact the claims function; current guidelines in the claims function; and policy changes and modifications. This may require attendance at various seminars or training sessions.Submits severe incident reports, reinsurance reports and other information to claims management as needed.Assists or prepares files for suit, trial, or subrogation. (Property/MD/Casualty)Initiates and conducts follow-ups via proficient use of claims systems and related business systems.Delivers a positive customer service experience to all internal, external, current and prospective Nationwide customers.Initiates and conducts follow-ups via proficient use of claims systems and related business systems. Allstate Insurance

08/2014-06/2015

PIP/MED PAY Claims Adjuster

Identify wage loss expenses and wage exposures on medical claims. Interact daily with customers taking statements and research medical records to understand nature and extent of injury and medical conditions. Plan and conduct coverage investigations. Evaluate medical claims for potential fraud issues, loss control and recovery in accordance with insurance policy contracts, medical bill coding rules and state regulations. Review a variety of claims related mail each day, including claim forms, medical bills, medical records, and attorney correspondence. Utilizing such systems as Mitchell and NextGen to complete daily work assignments.

Woodforest National Bank 09/2012- 07-2014

ID Theft/Forgery Investigator

Demonstrate excellent communication skills, both written and verbal, Demonstrate excellent organizational skills with the ability to prioritize workload and multi-task in a fast pace environment while maintaining attention to detail, General understanding of the fraud and identity theft/debit card industry processes and practices, General knowledge of bank services and products, Follow established procedures with fraud filters to identify potential fraud/ Identity theft, Review fraud filters; record issues; monitor unusual activity, Review fraudulent accounts to make closure decisions; send closure notifications, track and close accounts Responsible for processing department reports and department inboxes, Demonstrate ability to thoroughly research, investigate and analyze information, Develop relationships within the Bank and provide exceptional internal customer service, Maintain a high level of company and customer confidentiality, Follow established procedures and timelines in order to meet deadlines, Assist department management team with special projects as needed, Allocated Hold Harmless agreements, Review video and provide video to Law Enforcement, Work with Law Enforcement to pursue criminal charges in Forgery/ID Theft cases J.P Morgan Chase, Houston TX 1/2012 –09/2012

Risk Operation Analyst

Served as direct contact with customer establishing relationship through integrity and collaboration. Performed reviews on customers, accounts, transactions and items to ensure all transactions comply with bank policies and procedures. Ensured all accounts that have been compromised by account theft or takeover are restricted. Performed pre-screening for new customers and validity confirmation of deposits. Conducted review on daily deposits and performed investigations on suspicious check deposits. Reviewed and analyzed new Checking/Savings accounts to confirm the validity of the applicant and activity and taking the appropriate actions on accounts with potential risk to the company. KeyHighlight:

• Awarded top performing team member rank at number 9 out of 151. M&M Association’s 5/2006 - 1/2012

Consultant

Identified and analyzed all areas of potential risk threatening the assets, earning capacity or success of organizations in the industrial, commercial or public sector. Conducted forecasting on cost to the organization and predicting change and future trends. Ensured that organization's assets and public image are protected. Conducted research to assess severity of risk and statistical analysis to evaluate risk utilizing statistical software such as SPSS and SAS. Provided recommendation to reduce or control risk, which may involve an insurance strategy. Conducted review on all legal documents, ensuring all documents are in compliance with policies and procedures. Provided recommendations for improvements by presenting ideas through reports and presentation. Formulated and implemented contingency plans.

IKON 6/2002 –

11/2005

Senior Accounts Receivable Associate

Reviewed aging reports and proactively initiated calls to customers with past due balances to arrange for payment. Resolves customer complaints, researched account discrepancies, and corrected billing issues in an expedited manner. Facilitated all A/R balances initiatives, utilizing minimal DSO’s for specific accounts or ranges of accounts. Prepared credits, adjustments and refunds to customers, while also providing documentation for account resolution.

EDUCATION AND CREDENTIALS

• Bachelor of Arts, Major: Communication, Minor: Psychology, 8/2012

• University of Houston Downtown - Houston, TX

• Adjuster License All-Lines Expiration 11/2016

• Texas P&C License All Lines Expiration 02/2018

TECHNICAL SKILLS

Windows 8: PowerPoint: Microsoft Excel: Linux/Windows XP: Windows Vista: Microsoft Outlook: Word: Internet: Firefox: Microsoft Access: Cics: Paper Port: Roxio: SQL: Visual Basic: Mitchell:



Contact this candidate