Claims Adjuster Customer Service
Resume:
SOPHIA ROBINSON
Insurance Claims Adjuster
Mobile, AL 36695 ******.************@*****.***
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. Willing to relocate: Anywhere
Authorized to work in the US for any employer
WORK EXPERIENCE
CATASTROPHE, VIRTUAL INSIDE PROPERTY CLAIMS ADJUSTER 2020 to 2021 HOUSTON, TX
• Investigates claim damages and situation using internal and external resources. Investigation steps include speaking with the insured or other involved parties such as contractors, requesting and receiving a field investigation report, research on past claim activity, research on external websites for CAT event confirmation, and engaging vendors for services, material supply and/or pricing.
• Determines policy coverage through analyzing investigation data and policy terms, including whether claim will be approved or denied. Notifies insured of coverage or any issues. Establishes reserve levels at the beginning of handling a claim and adjusts as appropriate based on investigation findings.
• Handles and owns claims submitted by independent adjusters, including making coverage and reserve decisions, and reviewing work for accuracy.
• Maintains accurate and current communication with insured/claimant.
• Maintains accurate and current claim file documentation throughout the life cycle of claim cases.
• Determines and negotiates settlement amounts for damages claimed within assigned authority limits.
• Makes recommendations to management for settlement amounts outside of authority limits. Closes claim files upon completion of final payment.
HEALTHCARE TEAM MANAGER
GETIX HEALTH, MOBILE, AL
2017 to 2020
Provides regular supervision and mentorship over 15 to 17 subordinate staff; Ensure regular and effective communication with subordinate staff on performance, goals, and coaching; Facilitates daily agent coaching and development sessions in both written and verbal format; Participates in client related activities to include client calibration sessions and project planning; Identify and address agent training needs; Manage team's time entry to ensure 0% discrepancy rate; Manage program specific performance standards (i.e. AHT, Quality Scores, Sales, etc); Manage financial implications of attrition and attendance by maintaining program-specific goals; Manage staffing in accordance with program specific workflow (i.e. down-staffing, up-staffing); Diffuse irate customer calls as applicable L Provide agent support via handling escalated calls, as needed; Maintain up-to-date employee files and documentation; Ensure high level customer service is being practiced by all subordinate staff Patient Access Representative
ALORICA INC. - Mobile, AL
2015 to 2017
Adheres to hospital policies including confidentiality; assists with the orientation of new employees; • utilization proper body mechanics when moving equipment and or supplies that are necessary to perform essential functions; • Reports broken or malfunctioning equipment to supervisor or department head; • Accepts reservations, obtains social, financial, and personal data by personal interview or telephone; inputs accurate patient information on IS system and follows up for missing data; obtains copies of insurance and patient ID cards; correctly identifies patients; completes all admission/ registration, legal, financial, and medical forms and obtains required signatures; • Distributes and explains state and federally mandated information to patients; follows established downtime procedures; secures patient valuables; collects and receipts monies; assigns patients to appropriate bed and floor; performs general clerical duties including answering phones and maintaining files; performs duties using personal computer and word processing software; • Communications and uses appropriate customer relation skills with physician, patients, families, healthcare team and staff in person and via telephone; responds to overhead pages; • Maintains accurate and complete records by recording information in various logs, reports, and QI forms including daily bed check; • Completes all mandatory unit, education and hospital requirements; utilizes cost effective practices in performing all aspects of the job; adheres to current Infection Control and Safety Standards; participates in performance improvement activities through quality measurement or participation of ICARE process as assigned; accesses and accurately maintains electronic and paper medical records; • Regular and prompt attendance and the ability to work schedule as defined and overtime as required; related duties as required. Complete insurance verifications and insurance authorizations request.
Customer Service Representative
VERIZON (ALORICA INC)- Mobile, AL
2014 to 2015
Provides extraordinary customer service for an elite financial institution of customers via inbound phone contact, and appropriately document all transactions. Ensures that the customer experience is engaging by learning the customer's needs, utilizing a positive and knowledgeable approach, to address those needs. Offers additional support options/benefits/ products available to the customers. Works constructively in a high-paced team environment. Office Manager
International Shipholding Corporation
2007 to 2014 MOBILE, AL
Skillfully manage wide-range of office and sales support tasks, including accounts payable / accounts receivable and payroll processing. Leverage strong multitasking skills to manage customer service, data entry, invoicing, inventory control, merchandising, returns processing, and purchasing. Respond to customer inquiries in person and over the phone; liaise with cross-functional teams in support of customer needs. Manage calendars for three managers and two executive managers, including meetings / appointments and travel arrangements.
Police Dispatcher
Mobile Police Department
2001 to 2007 MOBILE, AL
Responsible for determining the nature of the calls they receive, as well as the location of the callers. Responsible for monitoring the location of emergency service personnel in their assigned territory. Directed the appropriate type and number of emergency service units to emergency scenes. Maintained communication with the dispatched units to monitor their response, in addition to maintaining communication with callers to monitor emergency situations and give first-aid instructions if necessary Customer Service Rep
Sears Telemarketing Inc
1999 to 2001 MOBILE, AL
Advises present or prospective customers by answering incoming calls on a rotating basis; operating telephone equipment, automatic dialing systems, and other telecommunications technologies. Influences customers to buy or retain product or service by following a prepared script to give product reference information. Documents transactions by completing forms and record logs. Maintains database by entering, verifying, and backing up data. Keeps equipment operational by following manufacturer's instructions and established procedures; notifying team leader of needed repairs. Maintains operations by following policies and procedures; reporting needed changes. Maintains quality service by following organization standards. Maintains technical knowledge by attending educational workshops; reviewing publications. Contributes to team effort by accomplishing related results as needed. Admissions Assistant
USA Medical Center
1998 to 1999 MOBILE, AL
Ensures an efficient admissions and/or registration process by interviewing patients, explaining policies, collecting data, verifying insurance, obtaining precertification’s as needed, obtaining extensions for patients that have been pre-certified, and completing required forms according to regulatory and departmental procedures. Will also be knowledgeable in secondary scheduling systems.
• Ensures complete and accurate records by performing daily review of specified reports/ charts and providing follow-up as appropriate; discharges patients daily, enters charges for tests/exams and supplies utilized, files transcription, and ICD-10 codes. • Functions as a customer service representative by providing administrative and customer support to meet departmental standards for customer and patient satisfaction. • Contributes to department goals by performing other tasks to meet departmental needs, and by assisting with special projects as assigned including but not limited to purging records older than six months, filing for nurses as needed, ordering supplies, managing return mail, maintaining collection log and preparing deposit daily, and processing faxes. • To help ensure a continuum of service may assist with room assignment and scheduling of procedures, equipment and/or services as necessary.
Supply Clerk- Order
United States Navy - Mobile, AL
1989 to 1998
store, check and issue Naval aircraft and aeronautical equipment and accessories, including flight gear. Prepare inventory reports and correspondence. Keep official publications up to date. Maintain financial logs and records. Operate computer systems that provide logistic support information for submarine supplies and accounting functions. Organize and operate Navy post offices, ashore and afloat.
Bishop State Community College 2013 to
2016
Bachelor's in Healthcare administration
Capella University
August 2010 to February 2013
High school or equivalent in General
Wp Davidson High School - Mobile, AL
September 1984 to May 1988
• ORGANIZATIONAL SKILLS
• DETAIL-ORIENTED
• MULTITASKING (8 years)
• OPERATIONS (2 years)
• Epic
• EHR
• EMR
• Cerner
• Billing
• Clerical
• Data Entry
• Filing
• MS Office
• Receptionist
• Sales
• Word
• Data Analysis Skill (10+ years)
Service Country: United States
Rank: E5
February 1989 to May 1995
ADMINISTRATIVE AND CLERICAL DUTIES
SKILLS
• Demonstrated capacity to provide comprehensive support for senior-level staff, including managing and coordinatingprojects and processes in support of effective business operations.
• Proven track record of accurately maintaining detailed records, generating reports, coordinating meetings, andmultitasking within fast-paced atmospheres.
• Adapt at managing and streamlining administrative processes to reduce errors, improve accuracy and efficiency, andachieve organizational objectives.
• Outstanding interpersonal, customer service, leadership, and organizational skills; thrive within detail-oriented, deadline- driven environments.
• Proficient in Microsoft Office Suite (Word, Excel, Outlook, PowerPoint) and managing, arranging, and coordinatingexecutive calendars, travel, contacts, conference bridges, appointments, and luncheons/events.
Contact this candidate