Tanya Wise

Huntersville, NC ad2dga@r.postjobfree.com 704-***-****

Insurance

Insurance Multi-Line Adjuster/Liability Adjuster Life and Health Agent Mediations/Negotiations Investigative Specialist Conflict Resolution/Medicare Licensed Agent/Educator

Detail-oriented, patient and personable Insurance Professional with 15+ years of experience in insurance liabilities, adjustment, client relations, bodily injury. Industrious, hardworking quick learner with expertise mitigating damages by ensuring compliance and quality throughout the entire claims process. Highly innovative, motivated, organized and systematic team player.

Professional Experience

Humana, Charlotte, NC – 2020 to Dec 2022

Experienced Licensed Medicare, Long-term Care, Supplement, Life and Health Agent

Build community relationships, interact daily with customers, external business partners through face-to-face and telephone interactions. Sold all Medicare products, educated all individuals on how the plans work, life and health, deductibles, prescriptions, copayments and coinsurance. Met and exceeded all sales goals.

Handle 40-50 calls a day

Ensemble Health Partners, Charlotte, NC – 2019 to 2020

Account Receivable Representative

Responsible for reviewing patient accounts and monitoring claims. Determine if the maximum amount of monies has been received and paid on an account. If the payment is less than expected, contact the Providers or check the web portals to determine if something was denied. Initiate the appeals process.

Determine what coverage is Primary versus Secondary

Handle 50 calls a day

Rebill claims to the correct Providers

Customer service, returning calls explaining insurance coverage, deductibles, copays, contacting insurance companies

Medical billing

Erie Insurance, Charlotte, NC – 2008 to 2019

Completed initiatives relating to employee benefits, successfully explaining all kinds of financial, life and health benefits.

Directed all arbitrations and mediations to yield a strong record of wins; 95% success rate for 15 years.

Tenured as a Liability Specialist, handling policy limit cases, coverage issues and high dollar claims. Responsible for interpreting insurance policies, determining liability and coverage. Handled the bodily injury cases from minor to significant injuries. Responsible for assessing the injury and putting a value on what the claim settlement was worth. Settlement ratio based on my injury analysis/evaluations was 99%.

Hired as a Multi-Line Adjuster, investigated and inspected all commercial/property and auto claims.

Inspected damage to homes/property to determine coverage and benefits allocation.

Interpreted all types of insurance policies for feasibility and knowledge.

Promoted into a Liability Adjuster, handling all types of individuals when investigating claims, or managing the bodily injury claims and negotiating and settling claims with attorneys.

Enhanced HR efficiencies, effectively managing entire benefits process for all personnel including life/health insurance, vision/dental processes, 401K and Flex plans.

Monitored status reports, streamlining workflow prioritization while delivering results to senior leadership teams that assist with decision-making process.

Utilized fundamental knowledge of computers and MS Office Suite to facilitate timely task and project closure.

Served as medical biller, accurately and efficiently completing all billing and payment activities, while entering codes and monitoring documentation.

Strengthened traceability by tracking benefits account information with zero discrepancies.

Fielded hundreds of calls per month, championing increased levels of customer satisfaction and conflict resolution success.

Gained proficiency within the underwriting process, healthcare and ancillary products, and health plans to sustain industry relevance.

PREVIOUS WORK HISTORY: Financial Planner, World Financial Group, VA prior to 2008

EDUCATION, LICENSURE & AFFILIATION

BA, Telecommunications Degree, Penn State University

North Carolina and South Carolina Adjuster Licensure

Local Charity Volunteer

Life and Health Licensure

Medicare Licensed Agent

Medicare Supplemental Agent

Medicare Long-term Care Licensed Agent

Anatomy License

Medical Terminology I and II

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