Tracie Weale

Mount Sterling, OH 740-***-**** adui81@r.postjobfree.com

I am a motivated and experienced claims associate who thrives in a fast-paced environment. I am agile, adaptable and drive positive results while cultivating strong relationships. I create a seamless experience with both internal and external partners. I am a Personal Lines expert and continue to build on the extensive knowledge I have gained in the last 12 years with my current company. I’ve assisted with co-creating and implementing quality processes by providing strong leadership and keeping business needs and collaboration top of mind.

Skills & Abilities

• Operational efficiencies and time-management skills

• Robust conflict resolution skills

• Reliable liaison for internal and external business partners

• Exceptional written and oral communication skills

• Maneuvers change in an exemplary manner

• Detail oriented

EXPERIENCE

CLAIMS MEDICAL SPECIALIST II, MI PIP 2013 – JUNE 2022 – NATIONWIDE MUTUAL INSURANCE COMPANY

• Responsible for investigation, negotiation, and resolution of claims in accordance with policy provisions, statute, best practice and jurisdictional requirements

• Reviewing claim data and guiding insureds and claimants through the claim process and options

• Looking for fraud indicators & working closely with our internal SIU partners; requesting surveillance when injuries and claims presented are questionable, reviewing for needs of Independent Medical Examinations

• Evaluating injuries and placing proper reserves on the file – benefits from $50K to Unlimited Lifetime benefits

• Handling Medicare ORM information, monitoring file for liens and forwarding to appropriate department for handling

• Utilize Auto Injury Solutions to determine if medical bills are within the UCR (usual, customary, & reasonable)

• Identify exposures and assign as applicable – Uninsured Motorist Bodily Injury, Underinsured Motorist Bodily Injury

• Review medical bills timely and ensure bills are in accordance to the policy, state, and statutory timely filing guidelines.

• Managing claims under PIP coverage including but not limited to: wage loss, household replacement services, medical bills/prescription medications, attendant care services, durable medical treatment, etc

• Monitor claimant’s injuries for severity and potential lifetime care needs. Place on financial model for lifetime treatment needs. Presenting high exposure models to higher-ups & the technical office Personal Lines Service Agent – May 2010 – 2013

• Licensed Insurance Personal Lines Property and Casualty Agent in the state of Ohio

• Servicing both Homeowner and Auto policies in over 30 states

• Receiving inbound, and outbound calls from and to both policy holders and agents

• Making changes to coverages on policies upon Agent or policy holder request • Adding/removing drivers/vehicles

• Following appropriate state guidelines at all times to ensure changes are being properly made

• Taking inbound calls from both policy holder’s and other insurance agents from local agencies

• Providing and exceptionally high level of customer service to ensure customers are always satisfied.

• Faxing, e-mailing all necessary documents upon request: Proofs of Insurance for both Home and Auto. Maintaining all trailing document

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