Objective:

To use my experience and education to obtain a career where I can prosper and grow with the company. I am looking forward to working in a fast pace environment where I can work independently to meet the goals and requirements set for the company to grow.

Education: Bachelor Degree – Health Service Administration Orlando, FL

University of Central Florida, August 2016

Accredited Claims Adjuster License Lake Mary, FL

University of Central Florida, March 2010

Summary of Qualifications:

-Able to master new concepts and procedures efficiently

-Proficient with Microsoft Office systems (including Word, Excel, and Power Point)

-Multitask and manages time efficiently and productively

-Knowledgeable in insurance billing and medical terminology

-Skilled in communicating orally and verbally

Experience:

2006 – Present Farmers/Bristol West Insurance Lake Mary, FL

2015 – Present Med/PIP Claims Adjuster

-Handle low to moderately complex Personal Injury and Medpay cases.

-Obtain facts to evaluate coverage, medical necessity and causation/damages.

-Ensure cost-effective resolution.

-Provide quality customer service and expedient claims resolution.

-Adhere to all state specific, federal, and HIPAA regulations.

-Thoroughly document all communication with the customer and coverage outcome.

-Manage deductibles and wages.

-Recognize coverage issues as well as jurisdictional issues.

-Manage medical payout and return-to-work strategies.

-Maintain organized claims to ensure efficient handling

-Review billing and codes to ensure proper coding is used.

-Process bills in a timely manner and follow up with providers on bills that need additional supporting documentation prior to payment.

-Issue payments to providers and provide the Explanation of Benefits with each payment.

May 2016 – August 2016 Optimotion Orthopedic Internship

-Schedule new patient appointments

-Manage waiting list and contact patients as earlier appointments become available

-Answer the phone and assist with patient questions or take message for the MA or PA

-Print and fax lab orders to the diagnostic testing facilities

-Correspond with patients by email and phone to remind them of upcoming appointments and documents needed prior to the appointment

-Contact medical providers by telephone, fax, email and online portals to confirm the appropriate amount was paid to the provider

-Generate a report on patients with an outstanding balance, contact them by phone and send a letter advising the amount due

2012 – 2015 Coverage/Glass/Tow Claims Representative

-Investigate policies using multiple systems to confirm date of cancellation or locate an active policy for the claim

-Review coverage and make payments according to the glass and tow limits for that policy or state

-Multitask throughout daily handling incoming calls, new and old claims, activity files, and emails

-Communicate the coverage status to the customers by phone and in writing

-Thoroughly document the claim with all activity such as coverage decision and all communication between the customers

-Respond to correspondences from attorneys, medical facilities and insurance carriers

2009 – 2012 Senior Customer Service Claims Representative

-Assist the customer with filing the first notice of loss when they have a claim

-Review and interpret coverage to the customers as it applies to their claim

-Handle difficult and escalated calls that may need additional review and/or special handling

-Fill in as acting supervisor managing a team of 10-12 people while current supervisors were out on leave/vacation

-Maintain team daily & monthly service goals

-Assist IT with troubleshooting to fix computer/system issues

-Supervise temporary employees hired during CAT season

-Assist with interview process for new hires

-Research and analyze date for coaching opportunities of team members

2006-2009 Customer Service Representative

-Build and maintain effective relationships with customers and agents

-Promptly overcome any potential problems and process complex customer calls

-Make changes to the policy per written and verbal request

-Review and explain policy premiums and payments

-Answers policy and coverage questions

-Review and explain renewal with the customers

Contact this candidate