ANGELIA MOORE

Memphis, TN ***** 901-***-**** ad29gz@r.postjobfree.com WWW: Bold Profile

PROFESSIONAL SUMMARY

Secure a responsible career opportunity to fully utilize my training and skills, while making a significant contribution to the success of the company. Ethical Auto Claims Adjuster with excellent customer service skills to take on multiple cases while meeting strict deadlines. Adept at determining the level of loss for auto claims cases and deciding on a fair compensation for clients. Strong organizational and communication traits.

WORK HISTORY

Auto Claims Adjuster, 08/2019 - 08/2023

AAS – 80401

Senior Technical GLBI Claims Adjuster

Conducting detailed information gathering, analysis and investigation to find solutions to issues that are numerous and undefined.

Reporting to senior management and underwriters on claims trends and developments. Investigating claims promptly and thoroughly

Analyzing claims forms, policies and endorsements, client instructions, and other records to determine whether the loss falls within the policy coverage.

Investigating claims promptly and thoroughly, including interviewing all involved parties. Managing claims in litigation

Managing diary timely and complete tasks to ensure that cases move to the best financial outcome and timely resolution.

Properly setting claim reserves, taking into account how different policy wordings impact the claims reserving process.

Identifying, assigning, and coordinating the assignment and coordination of expertise resources to assist in case resolution.

Preparing reports for file documentation

Enhanced customer satisfaction by delivering honest advice to policyholders in regards to repair work and body shop processes.

Carried and managed consistently heavy project workload through exemplary organizational, time management and collaboration talents.

Identified suspicious claims, escalating issues to supervisor for further investigation and analysis. Successfully negotiated settlements with claimants and insurers.

Assessed complex claims and accurately determined value of damages.

Analyzed complex data and prepared accurate and comprehensive reports for clients. Created detailed assessments of damages to property and vehicles.

Skilled at working independently and collaboratively in a team environment. Self-motivated, with a strong sense of personal responsibility.

Proven ability to learn quickly and adapt to new situations. Worked well in a team setting, providing support and guidance. Worked effectively in fast-paced environments.

Managed time efficiently in order to complete all tasks within deadlines. Demonstrated respect, friendliness and willingness to help wherever needed. Excellent communication skills, both verbal and written.

Passionate about learning and committed to continual improvement.

Proved successful working within tight deadlines and a fast-paced environment. Strengthened communication skills through regular interactions with others.

Organized and detail-oriented with a strong work ethic.

Adaptable and proficient in learning new concepts quickly and efficiently.

Used critical thinking to break down problems, evaluate solutions and make decisions. Paid attention to detail while completing assignments.

Worked flexible hours across night, weekend and holiday shifts. Developed and maintained courteous and effective working relationships. Identified issues, analyzed information and provided solutions to problems.

Participated in team projects, demonstrating an ability to work collaboratively and effectively. Evaluated and investigated over 519 auto claims in 2017 and decided whether insurer should pay claim

Medical Claims Adjuster, 04/1994 - 02/2018

Dr EP Cooper

Maintained knowledge of benefits claim processing, claims principles, medical terminology, and procedures and HIPAA regulations.

Verified patient insurance coverage and benefits for medical claims. Managed large volume of medical claims on daily basis.

Researched and resolved complex medical claims issues to support timely processing.

Paid or denied medical claims based upon established claims processing criteria. Evaluated medical claims for accuracy and completeness and researched missing data. Monitored and updated claims status in claims processing system.

Identified and resolved discrepancies between patient information and claims data.

Used administrative guidelines as resource or to answer questions when processing medical claims. Assessed medical claims for compliance with regulations and corrected discrepancies.

Followed up on denied claims to verify timely patient payment and resolution. Responded to correspondence from insurance companies.

Processed insurance payments and maintained accurate documentation of payments. Reviewed provider coding information to report services and verify correctness.

Generated reports on medical claims processing activities and results.

Delivered exceptional customer service to policyholders by communicating important information and patiently listening to issues.

Examined claims forms and other records to determine insurance coverage.

Read over insurance policies to ascertain levels of coverage and determine whether claims would receive approvals or denials.

Conducted day-to-day administrative tasks to maintain information files and process paperwork. Identified insurance coverage limitations with thorough examinations of claims documentation and related records.

Researched claims and incident information to deliver solutions and resolve problems.

Reviewed police reports, medical treatment records, and physical property damage to determine extent of liability.

Conducted comprehensive interviews of witnesses and claimants to gather facts and information. Reviewed and analyzed suspicious and potentially fraudulent insurance claims.

Analyzed information gathered by investigation and report findings and recommendations. Resolved complex, severe exposure claims using high service oriented file handling.

Investigated and assessed damage to property and reviewed property damage estimates. Reviewed new files to determine current status of injury claim and to develop plan of action. Analyzed information gathered by investigation and reported findings and recommendations. Evaluated original investigation reports and documents to resolve secondary concerns.

Determined liability outlined in coverage and assessed documentation such from police and healthcare providers to understand damages incurred.

Maintained contact with claimants and attorneys to determine treatment status. Followed up with insured individuals regarding premium and deductibles payments.

Clarified coverage of losses to policyholders and provided assistance in itemizing damages and finding alternative living arrangements.

Identified suspicious losses and contacted manager for investigative assistance.

Reviewed questionable claims by conducting agent and claimant interviews to correct omissions and errors.

Directed claims negotiations within allowable limit of $[Amount] and supported successful litigations for advanced issues.

Assisted homeowners by coordinating vendor services, emergency repair, cleaning and contractors. Visited customer locations to evaluate damage and provided cost estimates for remediation.

Worked with private investigators and attorneys on preparation of evidence, witness statements and other documentation in preparation for trial.

Interviewed agents and claimants to correct errors or omissions and investigate questionable claims. Collected evidence to support contested claims in court.

Followed up on potentially fraudulent claims initiated by claims representatives. Maintained suspicious claims database and prepared reports for supervisors.

Directed and coordinated various investigations conducted by field investigation team. Synthesized data into comprehensive quarterly written reports for management.

Established productive working relationships with public officials and law enforcement officers. Testified on behalf of agency as part of criminal and civic proceedings.

Directed claims negotiations within allowable limit and supported successful litigations for advanced issues

EDUCATION

WGU

MedicalAcademy

Dean's List All 4 Years Honor Roll All Years Completed AP course Professional Development

3.9 GPA

Ranked in Top 5% of class

SKILLS

Marketing

Project Management Budget Planning Social Media Planning Communication

Claim Handling Claims Assessments

Liability Determinations Medical Records Management Risk Assessment

Court Proceedings

Received 12 Employee Awards for customer service excellence.

Leadership

Local Suicide Chapter Vice president for the midsouth area.

Policy Interpretation

Multi-Line Phone Systems Corporate Policies and Procedures

Insurance Policy Coverage Knowledge Settlement Determinations

Claims Investigations Damage Mitigation Financial Accounting Damage Assessment

Fraud Detection Knowledge

Personal Interviews Medical Terminology Monitoring Accounts Internal Fraud

Auto Mechanics

Credit Card Transaction Processing Claims Process Explanation Deductible Collection

Body Shop Knowledge Salvage Value Determination Billing

Bookkeeping

Applying creative solutions which result in the best financial outcome.

Contact this candidate