Customer Service Insurance
Resume:
Rhonda Jackson Smith
Tampa, FL 33605
ac0noq@r.postjobfree.com
KEY SKILLS:
•Claims (Flood, Auto, Death, WC Insurance, Health
•State Farm Property Certification
•Licensed 620 Claims Adjuster,Excel, Word, Training and Auditing, Quality Assurance Testing
•FL, TX
•Citizen’s certification
•NFIP Certification
PROFESSIONAL EXPERIENCE:
September 2016-present
Claims Adjuster, Career Expert Staffing@ Wright Flood
●Examine and evaluate claims investigated by field adjusters
●Adjust reserves to provide reserves recommendations to ensure that reserve activity are consistent with the NFIP program requirements.
●Review adjuster reports to ensure that claim file has sufficient documentation to justify all coverage and damage decisions.
●Review building and property estimates.
●Pay and process claims with within designated authority levels.
●Handle claims toward resolution in a timely manner.
●Interact with policyholders, field adjusters, and experts to resolve coverage issues.
●Respond to all incoming correspondence on assigned files including denials.
●Send pertinent correspondence on denials and partial denials or other information.
●Determine whether additional expert(s) are required to assist field adjuster in properly resolving the claim.
●Identify subrogation and salvage recovery opportunities and initiate prompt recovery.
●Comply with all FEMA and the NFIP rules and regulations.
●Prepare waiver of the proof of loss where necessary.
June 2016-September 2016
APD Adjuster, Freestate Staffing @ Liberty Mutual
●Queue management of assigning claims
●Manage queues for specific claims for appropriate assigning
●Handle customers, vendors, insureds, and claimants through telephone and written reports.
●Arranges appraisals, reviews appraisal reports and communicates with customers, claimants, repair shops, etc.
●Rental management; set-up, cancel, extend.
●Secures the essential facts about accidents, accesses liability, negotiates settlements and communicates decisions effectively to customers and claimants.
●Verifies coverage claims.
●Review ISO, Police Reports, run Accurint; update claim status and claim information.
June 2015-December 2015
Bodily Injury Claims Representative, Banker’s Insurance @ State Farm Insurance
●Manage Bodily Injury Claims, investigate, negotiate, settle, close
●Manage Litigated calendars
●Review extent of damages to claimed injuries
●Make initial contact to all injured parties and other parties involved
●Obtain FOL including statements of legal liability and extent of damage to person’s property
●Update Injury Evaluation Details
●Obtain Authorization for Release of Information from providers
●Request medical bills and medical records
●Request liens; Other insurance carriers, Worker’s compensation, Medicare, Medicaid,
●Request police reports, Run Accurint, ISO, ADD123, and request PM06
●Obtain A/C and tort feasor information
●Work non-litigated diaries/calendars daily
●Process mail/correspondence accordingly
●Training associates on ECS procedures and system protocols
●Refer to SIU and Arbitration as deemed
March 2015- June 2015
Property Damage Claims Representative, Ultimate Staffing @Direct General Insurance
●Manage Property Damage claims via investigate, request and process closures
●Access damages to all vehicles
●Manage Litigated Calendars
●Make initial contact on all parties involved in auto accidents
●Customer service to involved parties
●Obtain FOL including statements of legal liability and extent of damage to person’s property
●Set-up vehicle repair shops with authorized agents as well as rental vehicle requests
●Request police reports, Run Accurint, ISO, ADD123, and request PM06
●Authorize repairs with body shops and repair facilities
●Review estimate and supplemental repairs; discuss with Appraiser, body shops, insured, claimants
●Set-up IAA tow; refer to Total Loss accordingly
●Schedule and set-up appraiser; DRP, Onsource, Innovation, Self-Application via cell phone
●Send appropriate correspondence in reference to Material Misrepresentation; Reservation of Rights and other correspondence/letters to everyone deemed, per accident
●Obtain A/C and tort feasor information
●Work non-litigated diaries/calendars daily
●Process mail/correspondence accordingly
●Training associates on ECS/Emedical procedures and system protocols
●Refer to SIU and BI
July 2014- November 2014
Property Damage Claims Representative, The Best IRS@ State Farm Insurance
•Manage Property Damage claims via investigate, request and process closures
•Access damages to all vehicles
•Manage Litigated Calendars
•Make initial contact on all parties involved in auto accidents
•Customer service to involved parties
•Obtain FOL including statements of legal liability and extent of damage to person’s property
•Set-up vehicle repair shops with authorized agents as well as rental vehicle requests
•Request police reports, Run Accurint, ISO, ADD123, and request PM06
•Authorize medical treatments and bills for payments
•Turn on auto pay, Set reserves for PIP/MPC
•Approve/process lost wage payments, mileage reimbursement, and household services
•Obtain A/C and tort feasor information
•Work non-litigated diaries/calendars daily
•Process mail/correspondence accordingly
•Send pertinent correspondence/letters to everyone deemed, per accident
•Training associates on ECS/Emedical procedures and system protocols
•Refer to SIU and BI
•Special projects; Legal e-billing (Bottom-line)
May 2013 – January 2014
QA Tester and Technical Business Analyst, IT, Intellect @Healthplan Services
•Test of the implicit requirements (usability, robustness, etc.)
•Test of the explicit requirements (client requirements)
•Test of the system in SIT and UAT using different types of tests and tools
•Production of all the necessary test artifacts
•Support to the client during UAT/QUA
•Coordination of defects resolution between the client and development during UAT
•Test of the system once deployed in Production
•Log/Report defects in HPQC
•Re-test and change status of test accordingly.
•Attend all conference calls in reference to internal and external updates
•Works and communicates with Project Manager, Business Analysts, Solutions Analyst, Development team, Enrollment, and Claims
Technical Business Analyst, Healthplan Services
•CASA Spec
•Receive SERFF
•Receive final documents
•Audit of SERFF File prior to loading
•Load/Map/Publish plans to configurator or Build plans and load to region (SIT, QUA, UAT)
•Build the benefit solutions catalog with data from SERFF, Rating, Finance, and Billing
•Updates provided by CASA or new SERFF files (load/map/publish again)
•Pay calendars
•Permanent System Change Request (PSCR) per request from Providers/Customers
•Attend conference calls in reference to internal and external updates
December 2010 – April 2013
Pip Claims Representative, IOS@ State Farm Insurance
•Manage PIP claims via investigate, request and process closures
•Manage Litigated Calendars
•Make initial contact on all parties involved in auto accidents
•Customer service to involved parties
•Obtain FOL including statements of legal liability and extent of damage to person’s property
•Set-up vehicle repair shops with authorized agents as well as rental vehicle requests
•Request police reports, Run Accurint, ISO, ADD123, and request PM06
•Authorize medical treatments and bills for payments
•Turn on auto pay, Set reserves for PIP/MPC
•Approve/process lost wage payments, mileage reimbursement, and household services
•Obtain A/C and tort feasor information
•Work non-litigated diaries/calendars daily
•Process mail/correspondence accordingly
•Send pertinent correspondence/letters to everyone deemed, per accident
•Training associates on ECS/Emedical procedures and system protocols
•Refer to SIU
•Special projects; Legal e-billing (Bottom-line)
June 2007 to May 2009
Account Specialist Metlife
●Coordinate with Account Managers in managing account activities and processes.
●WC, STD, LTD-LIFE, MEDICAL, DENTAL AND VISION coverages.
●Analyze and manage account renewal process.
●Analyze and resolve client queries in accurate and timely manner.
●Maintain positive working relationship with clients for business growth.
●Develop effective business presentations according to the client needs.
●Develop and maintain client reports.
●Review reports for accuracy and integrity.
●Manage endorsement requests and change requests from customers.
●Develop account management plan to meet business objectives.
●Provide excellent customer service to ensure customer satisfaction.
●Organize staff training for performance and skill developments.
●Ensure client deliverables are in accordance with company standards.
●Execute and manage assigned work within allotted timeline and budget.
●Review and manage fund transactions, payments, invoicing, remittance, etc.
●Organize account meetings and provide agendas and meeting notes.
Kennedy Law Group, Legal Assistant, 2006-2007
AIG, WC Claims Representative, 2005-2005
Direct General, Claims Representative, 2004-2005
EDUCATION
University Of Phoenix 04/09 to 06/09, AIU Online, 06/09 to 07/10, FloridaA&MUniversity, 8/87 to 8/88
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