To Rhonda Johnson
P.O. Box ******
Dallas, TX ***74
214-***-**** (cell)
*******@*********.***
Accomplished professional with more than 15 years experience within the
Insurance Industry. Experience working with Accidental and Occupational
claims and Credit Life and Disability Claims. I have the know-how in multi-
tasking, organizing and team-building. Special areas of concentration:
Customer Service in Call Center Environment
Database Management
Claims Processing and Investigations
PROFESSIONAL EXPERIENCE
Dearborn National Life Insurance, Dallas, TX
SR. CLAIMS CUSTOMER SERVICE REPRESENTATIVE (June 2008 to December 2012)
Maintain a high-level of Customer Service working with Group Life,
Individual Life, STD and LTD claimants and policyholders. Duties included
maintaining Customer Service Email box, Telephonic Claims Intake and
handling Escalated calls as needed. Call Center calls consisted of frequent
communication with attorneys, Group representatives, Claimants, State
agencies such as ERS and U.T., reinsurers and other insurance companies to
exchange claim information via telephone as well as email transmission.
Special Insurance Services, Dallas, TX
CLAIMS EXAMINER (November 2005 to May 2008)
Adjudicated intercollegiate benefit claims and processed medical claims for
payment. Requested all information as needed from internal or outside
sources to ascertain completeness and validity of claim; including the
coordination of benefits information. Analyzed and answered inquiries
regarding claim adjudication, including method of payment, co-pay or
deductible amounts, and/or reason for denial. Utilized CPT codes and other
payer codes and researched claims as needed and responsible for
correspondence.
ELIGIBILITY SPECIALIST (June 1992 to March 1999)
Interpreted policyholder's policies and plans by maintaining claim records.
Verified group and individual enrollment through premium verification and
policyholder's records to establish an enrollees benefit under either the
Occupational Plan or ERISA Plan. Responsible for training all new
Eligibility Specialist and monitored on a regular basis Provider's Tax
Identification Numbers according to established guidelines. Assisted in the
conversion of a new Claims System and trained as an Underwriting Clerk.
Served as a back-up to Customer Service and processed premium as an Account
Payable Clerk.
CLAIMS ADMINISTRATOR
Reviewed claim forms for completeness, transmitted reports, insurance
claims information, physician statements for disability and medical bills
for payment to the Insurance Carrier. Responsible for corresponding and
answering inquiries regarding claim adjudication, including method of
payments and maintained claims records. Maintained claim files for the
Claim Department.
Resource Life Insurance subsidiary of Aon, Inc., Dallas, TX
CLAIMS ANALYST (March 1999 to May 2005)
Acquired by Cambridge Integrated Company
Investigated Short and Long Term Disability claim payments against the
terms and provision of the Certificate of Insurance. Conducted telephone
interviews with insured in order to determine return to work status,
gathered medical records and physician reports to establish the extent of
company liability. Recommended files for Legal Review and Management
Review. Negotiated insured's accounts back into good standing. Responsible
for answering any inquiries regarding claim decisions and coordinated
correspondence.
Sears Logistics Services, Dallas, TX
LOGISTICS CONSULTANT (October 1991 to August 1992)
Dispatched drivers to customer's home and prepared special handling
instructions for delivery drivers. Checked inventory for Sales Associates
and conducted customer inquiries.
SJA Brokerage, Dallas, TX
LICENSING SPECIALIST (September 1988 to December 1990)
Acquired by USI, Inc.
Maintained agent information for licensing purposes and collected licensing
fees. Monitored and reviewed licensing renewals for company producing
agents. Managed agent hierarchy for commission purposes and Marketing
support.
EDUCATION/CERTIFICATIONS
Dallas Baptist University, Dallas, TX
Graduated: May 2002
Healthcare Administration/Business Administration
Texas Property and Casualty Adjuster Certificate of Completion 2008
LOMA (Life Office Management Association, Inc.) certificate 280 and 290