Customer Service Medical
Resume:
Roxann's InformationLocation: VIRGINIA BEACH, VATitle: CASUALTY CLAIMS EXAMINERExperience: 9-12 yearsWork Types:
Willing to Relocate: NoWilling to Travel: Few times a monthCareer Level: IntermediateWork Status: U.S. CitizenInterests:
Member Since: 2011-12-30 Helpful Links
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4912 Brookeway Dr
Virginia Beach, VA 23464
757-***-**** ********@*****.***
Roxann Case-Hicks
Skills Summary: Highly experienced, talented and dependable claims representative with more than nine (9)
years experience in the insurance field and more than 10 years in the medical/health insurance field.
Work Experience
07/ 09 – 10/11 USAA Norfolk, VA Claims Service Examiner - Salary $67,669.94 40 hr wk
-Provide claims service to members/customers regarding complex and severe auto/property claims. Investigates,
valuates and equitably settles claims in accordance with the terms and conditions of the policy contract
applicable to the liability facts and damages.
- Establish and monitor appropriate claims reserves. Evaluate and negotiate settlement of claims within
established settlement authority limits. Refer files to appropriate departments as file investigation warrants.
- Consider alternative methods of settlement to include structures.
- Provide training, file handling guidance, and coaching to less experienced claims staff.
- Officially commended for initiative, enthusiasm, tenacity, persuasiveness, intense customer focus and
dependability in performance evaluations.
- Recognized life events and gaps in coverage - directing membership to correct enterprise to obtain additional
products.
- USAA Pride Team Member
- Subrogate against the responsible party or a portion or all payments that was made.
09/06 – 07/09 USAA Norfolk, VA Casualty Claims Adjuster - Salary $58,708 40 hr wk
- Provide claims service to members/customers regarding moderate to complex auto claims. Investigates,
valuates and equitably settles claims in accordance with the terms and conditions of the policy contract
applicable to the liability facts and damages.
- Establishes and monitors appropriate claim reserves. Evaluates and negotiates settlement of claims within
established settlement authority limits. Refers files to appropriate departments as file investigation warrants.
- Considers alternative methods of settlement. (Structure settlements if warranted)
- Creates loss reports, confirms coverage, explains procedures and answers inquiries for adjusting auto and/or
property claims.
- Know our members, understands their needs, and provides appropriate solutions.
- Provide training, file handling guidance, and coaching to less experienced claims staff.
- Recognized life events and gaps in coverage - directing membership to correct enterprise to obtain additional
products.
- Subrogate against the responsible party or a portion or all payments that was made.
10/04 – 10/06 GEICO Virginia Beach, VA Telephone Claims Rep II - Salary $41,895 38.75 hr wk
- Recognize and verify applicable coverage in a timely manner.
- Resolve any coverage issues.
- Subrogate against the responsible party or a portion or all payments that was made.
- Provide claims service to insureds/customers regarding moderate to complex auto.
- Investigates and adjusts moderate to complex auto claims presented by or against our insured’s to ensure claim
validity, legal liability and equitably settles claims in accordance with the terms and conditions of the policy
contract applicable to the liability facts and damages.
- Establishes and monitors appropriate claim reserves.
- Refers files to appropriate departments as file investigation warrants.
- Considers alternative methods of settlement. (Structure settlements if warranted)
- Process 1st party medical bills within 10 days no greater than 30 days.
- Excellent customer service, organization and time management skills.
- Excellent verbal and written communications skills
11/03 – 10/04 GEICO Virginia Beach, VA Telephone Claims Rep I - Salary $29,640.45 38.75 hr wk
- Recognize and verify applicable coverage in a timely manner.
- Resolve any coverage issues.
- Provide claims service to insureds/customers regarding auto claims. Investigates, valuates and equitably settles
claims in accordance with the terms and conditions of the policy contract applicable to the liability facts and
damages.
- Subrogate against the responsible party or a portion or all payments that was made.
- Establishes and monitors appropriate claim reserves. Evaluates and negotiates settlement of claims within
established settlement authority limits.
- Refers files to appropriate departments as file investigation warrants.
- Considers alternative methods of settlement. (Structure settlements if warranted)
- Process 1st party medical bills within 10 days no greater than 30 days.
- Excellent customer service, organization and time management skills.
- Excellent verbal and written communication skills.
11/02 – 11/03 GEICO Virginia Beach, VA Claims Service Representative - Salary $27,726 38.75 hr wk
- Recognize and verify applicable coverage in a timely manner.
- Resolve any coverage issues.
- Interview customers who involved in an automobile loss of any kind. Through the interview process you make
your liability decision regarding the company’s liability.
- Refers files to appropriate departments as file investigation warrants.
10/99 – 7/02 Sentara Healthcare Norfolk, VA Supervisor - Salary $40,061 40 hr wk
- Manage the day-to-day work-flow for a staff of 50 (claims processors, member services, accounts services and
CSAs).
- Resolve any coverage issues.
- Human resource management (performance appraisals, monthly, quarterly and yearly evaluations along with
corrective action plans and disciplinary action plans).
- Payroll utilizing the KRONOS system.
- Identify opportunities for improvement, recommend solutions and implement recommendations to maximize
effectiveness of the unit.
- Support employees by being a resource for questions, clarifications, and assist with daily task.
- Maintain company goals for member service 3.5 abd rate, .25 sec ASA and 80% of calls answered within 20
sec. For claims 99% financial accuracy, 97% processing accuracy, 96% check accuracy and 80% of claims paid
within 30 days.
03/99 – 10/99 Sentara Healthcare Virginia Beach, VA Operations Data Analyst - Salary $32,115.20 40 hr
wk
- Maintain provider database to include update, data entry of all contracted and non-contracted provider for
example: address changes, contract renewal information and elimination of duplicate provider numbers.
- Champion for Primary Care Physician and OB/GYN databases.
- Multiplan provider verifications.
03/98 – 03/99 Sentara Healthcare Virginia Beach, VA Member Service Rep/Claims Processor – Salary
$26,225.60 40 hr wk
- Answer incoming calls from both members and provider and take appropriate steps to resolve all concerns
(took approx. 85-100 calls daily)
- Maintained the provider/member correspondence que with a lag time of 0-3 days.
- Process medical claims for payment or denial.
- Assisted with member enrollment.
- Team Leader which included handling difficult member and provider calls. Ran daily statistic reports and
mentors and trained new employees.
04/97 – 03/98 Sentara Healthcare Norfolk, VA Chaplaincy Secretary II - Salary $18,720 40 hr wk
- Routine secretarial duties for staff of three (3) and 25 volunteer chaplains to include scheduling, maintaining
calendars, taking minutes, make travel arrangements, vouchers for travel and payroll.
- Supervise Chaplain Interns and volunteer support staff in the absence of the staff chaplains.
- Required excellent customer service, communication skills both verbal and written, and a high degree of
confidentiality.
- Responsible for the Bereavement Support Services.
- Train new employees on the CHIPS system.
- Prepare death certificates and send to provider(s) for signature/completion.
- Notary.
Professional Certifications
- Certified Subrogation Arbitrator
Education
- 1981-1984 Elmira Business Institute Elmira, NY
Certificate Executive Secretarial w/ Medical Election GPA 3.16
-1981-1984 Elmira Free Academy Elmira, NY Diploma
References:
Rosier Neil-Perry 757-***-**** ********@***.***
Lauren Lohman 757-***-**** *******@*****.***
Rebecca Colleran Nelson 757-***-**** **********@*******.***
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