AUDREY

KELSO

I N S U R A N C E

P R O F E S S I O N A L

ABOUT ME

Dynamic claims adjuster with drive and experience providing a superior level of customer service to clients. Bringing forth the ability to properly investigate a situation and resolve claims quickly in accordance with company and regulatory guidelines. Demonstrating consistent execution of best claim practices and a commitment to industry and company ethics.

AREAS OF EXPERTISE

Medical Insurance

Property & Casualty Insurance

Disability Insurance

Life Insurance

Personal Investments

Retirement Planning

GET IN TOUCH

Address: Arlington, TX 76002

Phone: 720-***-****

Email: ad2sfp@r.postjobfree.com

PROFESSIONAL HISTORY

Claim Specialist- Bodily Injury

Evaluate and investigate policy coverage, liability and damages in a timely manner following a set of general claim and statutory guidelines. Establish initial reserves for all potential exposures and adjust as appropriate throughout the claim

Attend arbitration, meditations and other settlement conferences as needed. Conducted claims investigations by obtaining written statements, preparing reports, researching public records and conducting personal interviews. Establish and maintain appropriate diary of open claims following company guidelines.

Determine an appropriate reasonable range of value to negotiate fairly with unrepresented claimants based on the merits of their case. Draft precisely accurate settlement agreements in compliance with state laws that also provided protection to policy holders and insurance carriers. State Farm December 2016 to September 2022

Represented Casualty Claims Specialist- Contingent Review & determine course of action on each file assigned, utilizing technical knowledge & experience for the purpose of supporting final disposition of a loss. Conduct thorough investigations and keep accurate and relevant documentation of file activity on each claim assigned including coverage, liability status, and damages that are applicable for each claim.

Process bodily injury, and coverage claims in accordance with established office procedures.

Work closely with third parties, plaintiff counsel and Claims Director to determine necessary injury and coverage investigation.

Research case and statutory law in order to conduct proper claim investigation. Document policy status, coverage, liability and damages on all claims and notify re- insurer on qualifying claims.

Prepare and present claim evaluations for the appropriate settlement authority. Maintain reasonable expense factors.

Lonestar MGA (Non-Standard) May 2023 to Present

AUDREY

KELSO

I N S U R A N C E

P R O F E S S I O N A L

GET IN TOUCH

Address: Arlington, TX 76002

Phone: 720-***-****

Email: ad2sfp@r.postjobfree.com

Registered Financial Services Consultant

Built and deepened productive relationships with prospective and competitive customers to drive sustained growth.

Worked with clients to develop financial planning strategies and solutions through evaluation of finances.

Monitored changes in financial markets and kept clients informed of latest developments.

Managed client financial portfolios to minimize risk and optimize returns. Prepared detailed financial reports to monitor and assess portfolio performance. Advised clients on favorable investment opportunities to meet established financial goals.

Developed and implemented risk management strategies to minimize financial losses.

Responded to inquiries from clients and provided financial advice to drive fiscal growth.

Maintained updated records of all financial transactions to support traceability. TIAA-CREF 2014-2015

Med-Pay Tech

Managed large volume of first-party medical claims on daily basis. Working closely with the SIU contact to determine possible medical fraud and/or billing of claims by providers

Following the policy guidelines and issuing coverage to the correct injured parties, including obtaining any required forms

Taking incoming calls and providing customer service, which includes helping with general questions

Ensuring payment amounts and endnotes are accurate on bills processed Paid or denied medical claims based upon established claims processing criteria. Maintained knowledge of benefits claim processing, claims principles, medical terminology, and procedures and HIPAA regulations. Identified insurance coverage limitations with thorough examinations of claims documentation and related records.

American Family Insurance 2015-2016

Claims & Referral Processor II- Contingent

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

Communicated effectively with members, finance, and clinical departments. Paid or denied medical claims based upon established claims processing criteria. Used administrative guidelines as resource or to answer questions when processing medical claims.

Managed large volume of medical claims on daily basis. Reviewed provider coding information to report services and verify correctness. Monitored and updated claims status in claims processing system. Followed up on denied claims to verify timely patient payment and resolution. Evaluated medical claims for accuracy and completeness and researched missing data.

Verified patient insurance coverage and benefits for medical claims. Kaiser Permanente April 2016 to September 2016

AUDREY

KELSO

I N S U R A N C E

P R O F E S S I O N A L

GET IN TOUCH

Address: Arlington, TX 76002

Phone: 720-***-****

Email: ad2sfp@r.postjobfree.com

EDUCATIONAL HISTORY

Colorado Christian University

Master of Arts, Education, Curriculum, and Instruction May 2009 Colorado Christian University

Bachelor of Science, Business, Organizational Management & Human Resources May 2002 CERTIFICATIONS

International Association for Six Sigma Certification Lean Six Sigma Green Belt Certification

Texas Department of Insurance

Adjuster- All Lines

Disability Analyst

Trained new team members in policies and procedures and offered insight into best ways to manage job tasks and duties.

Maintained daily status of assigned cases to direct appropriate case progress. Observed strict procedures to maintain data and plan participant confidentiality. Reviewed annuity applications and interpreted their contracts. Maintained a working knowledge of Survivor Benefits, TPA, Wealth Management- Minimum Distribution Options, and more.

TIAA-CREF 2000-2003

Benefits Specialist

Trained new team members in policies and procedures and offered insight into best ways to manage job tasks and duties.

Observed strict procedures to maintain data and plan participant confidentiality. Reviewed annuity applications and interpreted their contracts. Maintained a working knowledge of Survivor Benefits, TPA, Wealth Management- Minimum Distribution Options, and more.

TIAA-CREF 2006-2014

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