Customer Service Medical
Resume:
Edward B. Smith
Cherry Hill, NJ 08002
*********@*****.***
Objective: To obtain a challenging and a rewarding career where my experience within the insurance industry can be effectively utilized.
Experience:
1/ 2016 – present CURE Auto Insurance, Princeton, NJ Senior Bodily Injury Representative
Investigate, litigated bodily injury auto claims by interviewing the claimant and witnesses, consulting police records and inspecting vehicle damage in accordance to state specific statues resolving liability exposure.
Identifies potential suspicious claims and refers to SIU and identifies opportunities for third party subrogation.
Prepares for and attends trials, hearings and conferences and reports to Home Office and local management on status. Confers with trial counsel and prepares trial reports.
Communicates with policyholders, witnesses, and claimants in order to gather information regarding claims, refers tasks to auxiliary resources as necessary, and advise as to proper course of action. Responds to various written and telephone inquiries including status reports and ensures adequacy of reserves.
Accountable for security of financial processing of claims, as well as security information contained in claims files.
Updates files and provides comprehensive reports as required.
Responsible for managing the practices and billing activities of outside and in-house counsel.
10/2008 – 2/2016, New Jersey Guaranty Association, Basking Ridge, NJ
2/2011- 2/2016 – Senior GL/UMBI Adjuster
Investigate and reviews factual information to determine coverage and/or liability of all parties to the claim. Resolves complaints, manages pending claims to meet company quality criteria.
Assign defense counsel to file in response to summons and complaints in which entity named as defendant.
Properly evaluate complaint s and case documents to determine dismissal or settlement based on appropriate review of coverage and liability.
10/2008-2/2011, Senior PIP Adjuster
Responsibilities consist of handling NJ PIP claims, Medical Cost Containment, Reviewing and processing medical bills, conducting 24 hour contact on new claims.
Handling Arbitration claims consisting of negotiating possible settlement and assigning defense counsel as needed.
Maintain comprehensive documentation of claim information for assigned files. Provide complete, courteous and timely customer service to aid in the settlement process
7/2006 – 10/2008, Mercury Insurance Group, Bridgewater, Senior Casualty Adjuster
Investigate claims by obtaining relevant loss information from insured’s, claimant, witnesses, and other interested parties, through the use of claimant and witness statements, police reports, medical expense information, assigned outside investigation work to appropriate field representative.
Analyze and evaluate liability, subrogation potential and extent of injury and loss based on prescribed settlement authority and negotiate settlement of claims; refer claims which exceed personal authority to supervisor with recommendation.
Ensure payments are issued; close claim files according to company procedure.
Maintain comprehensive documentation of claim information for assigned files. Provide complete, courteous and timely customer service to aid in the settlement process.
Maintain diary of files in pending and update file information to ensure accurate record of claim; continually review and monitor progress of expense of claims in pending file.
5/2003 – 7/2006, Clarendon Insurance Company, Saddle Brook, NJ Senior Casualty Adjuster
Responsibilities consist of handling of NJ PIP Claims, Medical Cost Containment, Review and process medical bills, conduct 24 hour contact on new claims. Handled Litigation and Arbitration claims settlement and defense as needed.
7/1995 – 5/2003, Robert Plan Corp of New York, Edison, NJ
1/2003-5/2003, No Fault Claim Adjuster/Assistant Supervisor
Responsibilities consist of processing medical bills of NJ and NY claims and providing medical management, cost projection, setting adequate reserves, making first contacts as maintaining compliance and diary.
Assigned new claims, gave directions, completed daily and weekly reports for management.
7/1995 – 1/2003, PIP Adjuster
Examine files to determine possible reimbursement, recovered 50%-100% liability on paid NJ Personal Injury claims.
Responsibilities also included phone coverage, filing and date entry.
Education:
South Brunswick HS 1986-1990
Middlesex County College 1990-1992
Connecticut School of Broadcasting 2001
References:
Maria Delossantos, LPN
Senior Medical Management Coordinator-CURE Auto
Edward Sroka
SIU Investigator-Liberty Mutual
Steven Lisner
Assistant Director of Medical Compliance-NJPLIGA
Contact this candidate