Claims Adjuster
Resume:
CHRISTINE WASHINGTON
Winter Haven FL 33884
****************@*****.***
CLAIMS ADJUSTER / PROJECT SPECIALIST/ TRAINER
Excellent communication and negotiating skills, with the ability to de-escalate requests to speak with upper management.
Excellent training skills with the proven ability to ensure quality service and customer satisfaction, while continuing to prioritize multiple time-sensitive tasks.
Excellent time management skills.
Self-starter and a fast learner.
I provide my team with a positive influence by having an optimistic attitude and diligent work habits.
PROFESSIONAL EXPERIENCE
Best IRS/ASI-Progressive September 2017 – Present
Home owner/Commercial Catastrophe Adjuster
Adjusting hurricane Harvey & Irma claims
Duties:
Daily inventory of 130 homeowner claims, reviewed estimates for accuracy and applied payments per insureds policy and authorized authority.
Reviewed all estimates for accuracy
Collaborated estimates when coverage or pricing was in error.
Determined the need of specialty vendors (i.e. engineer, HVAC, electrician etc.)
Worked directly with contractors and field adjusters to ensure proper handling of claim so all damages were addressed and completed according to policy, all while offering remarkable customer service.
CNC/State Farm Insurance August 2016 - August 2017
Complex Property Damage/Commercial Adjuster
Duties:
Assisted Subrogation by maintaining immaculate files with detailed documentation suitable for court/ Arbitration.
Litigation file review
Reviewed photos, interviewed witnesses, reviewed accident scenes, obtained recorded statements.
Evaluated, negotiated, determined liability & resolved disputes.
Paid claims with authorized authority
E.A RENFROE/State Farm Insurance April 2013 - July 2015
Bodily Injury Adjuster:
Duties:
Managed daily inventory of 150 bodily injury claims.
Settled 5 to 10 claims daily while reviewing at least 30 claim files and receiving inbound calls
Negotiated settlements with attorneys, claimants, and/or assigned designee.
Arranged for expert inspections involving third party or potential fraud actions as needed.
Settled claims with authorized authority
CTLU/ACC ASSIST (Total Loss.)
Duties:
Investigated, evaluated, negotiated and settled 1st and 3rd party claims, issued payments accordingly.
Determined liability, interviewed witnesses, recorded statements, reviewed police reports, etc.
Determined ACV through Auto source vendor and appraisal experts on un-recovered theft claims.
Moved vehicles timely to mitigate storage fees and provide early tow to salvage facility by working close with the owner and repair facilities.
Managed and controlled damages through the proper use of cost containment tools (i.e. mitigate storage, and rental expenses.)
Managed total loss settlement processes and rental expenses by working closely with appraisers, rental facilities, body shops, and salvage vendors.
Additional Job history
DELL/PEROT (Remote) August 2013 - March 2013
United Health care:
Duties:
Processed and adjusted medical claims.
Data entry and conversion associate.
JACOBSON SOLUTIONS (Remote) May 2011 - July 2013
Monroe, Health plans:
Duties:
Adjusted Medicare and Medicaid claims for proper payment.
HCSC, Richardson TX:
Duties:
Adjusted all claim types for proper payment.
KAISER, Stockton CA:
Customer Service for Medicare Advantage
Duties:
Answered phone calls and addressed any concerns for policy holders of all lines of insurance.
MONROE, Health plans: Rochester, NY:
Duties:
Processed error claims.
BROADPATH SOLUTION (Remote) August 2011 - November 2011
BCBS KC, Kansas City: Federal Employee Personnel (FEP)(Remote)
Duties:
Adjust Claims
COB, Professional, Institutional, Medical and Workman’s Comp.
HEALTH NET, INC. Woodland Hills, CA November 2005 - July 2010
Claims Examiner/Customer Service
Duties:
Processed and Adjusted all claims
Lead processor for Special projects, Benefit testing.
HMO, PPO, FFS, POS, FLEX, Medicare, and Medical Claims.
Excellent customer service skills.
Processed Refunds.
Received overflow of customer service phone calls.
Provided dispute resolutions for providers and member.
Claims Auditor.
WELL POINT/ BLUE CROSS November 1997 - August 2005
Sr. Claims Examiner/Configurations UAT testing
Duties:
Interpreting medical reports to ensure the proper processing of claims.
Trained and developed my department & management whenever benefits changed.
Processed and adjusted COB, DME, Medical, Medicare Advantage, PPO, HMO, Workman Comp and Blue Card Claims.
Received inbound and outbound customer service calls.
Direct contact for Medical Review Department (MRU).
Special Projects Coordinator
Benefit matrix reviewer
TECHNICAL
ECS
EXACTIMATE
SYMBILITY
BLUE CHIP
FACETS 4.71
CITRIX
IMNU
WGS
PFIN
CLAIM FAX
PRAP
EZ CAP
SSNI
TCHI
CALL CARE BROWSER
MERCK MEDCO PHARMACY
MACESS
LEGACY
AMYSIS
PEGASUS
ACTIVE ADJUSTER LICENCES:
Texas – 1911034 (Home State)
Alabama – 744599
Alaska - 100132299
Arizona – 1076758
Connecticut - 002564667
Delaware – 300*******
Florida – W212888
Georgia – 3093400
Louisiana – 739385
Maine - ADN289879
Michigan – 16948116
Mississippi – 10416429
Nevada – 969687
New Hampshire – 2374681
Oklahoma – 010*******
South Carolina - 724414
Utah – 480223
Vermont – 3256520
Wyoming – 26211
References Upon Request
Contact this candidate