Claims Adjuster Service Call
Resume:
Cindi Lounds
Towson, MD *****
**************@*****.***
Objective: To obtain a senior level position in a professional environment; that will allow me to utilize the professional skills I have acquired, and further my knowledge to become successful. Authorized to work in the US for any employer
Work Experience
Claims Adjuster II
Marriott International - Maryland
March 2022 to Present
• Investigate claims promptly – taking statements as necessary – to determine liability/compensability.
• Evaluate damages and pay benefits as prescribed by law and/or Marriott policies and procedures.
• Secure necessary documentation to facilitate timely loss adjustment and maintain primary responsibility for settlement decisions up to individual authority.
• Complete and monitor timely WC payments/state filings
• Monitor and actively manage WC medical treatment with the goal of minimizing disability. Consult Occupational Health Services as necessary.
• Participate in the Service Call program and complete required Service Call reports detailing current case status.
• Evaluate claims for potential third party or subrogation recovery.
• Assist in settlement of litigated cases.
Inside Property Claims Adjuster
Allstate Insurance - United States
August 2021 to May 2022
• Review assigned incoming claims and make initial contact with Insured
• Conduct claim investigation to determine cause of loss and make coverage decision
• Perform virtual inspections and write estimates - Xactimate / XactAnalysis
• Maintain communication channels, follow up, and status updates with customers, contractors, and various vendors
• Verify policy coverage and deductible, document claim files, upload various files, and review record updates pertaining to various stages in the claim life cycle
• Monitor email and other work queues
• Prepare and send state specific letters and correspondence to the insured
• Negotiate settlement and payment of claim with the insured, attorney, and/or public adjuster Licensed Claims Adjuster
Arch Insurance Group
May 2018 to November 2020
Analyze coverage
Monitor claim developments
Investigate the claim including legal and damage analysis Negotiate settlements and makes reserve recommendations Work closely with Underwriters and the Executive Assurance Claims team to communicate claim developments and trends
Senior Claims Examiner/Client Consultant
Trizetto
February 2016 to April 2018
• Examining and entering complex claims for appropriateness of care and completeness of information in accordance with accepted coverage guidelines, ensuring all mandated government and state regulations are consistently met.
• Processing claims for multiple plans with automated and manual differences in benefits, as well as utilizing the system and written documentation to determine the appropriate payment for a specific benefit.
•Workers Compensation claims investigation and processing
•Third party pay and chase workers compensation claims processing and payment retractions
• Approving, pending, or denying payment according to the accepted coverage guidelines.
• Identifying and referring all claims with potential third party liability (i.e., . subrogation, COB, MVA, stop loss claims, and potential stop loss files).
• Maintaining internal customer relations by interacting with staff regarding claims issues and research, ensuring accurate and complete claim information, contacting insured or other involved parties for additional or missing information, and updating information to claim file with regard to claims status, questions or claim payments.
Patient Account Rep III
University of MD FPI
January 2014 to January 2016
•Review accounts to determine appropriate insurance follow up
•Accounts Receivable, Medicare Parts A&B Medicare Advantage and Workers Compensation Claims
•Perform charge entry
•Post payments and rejections to patients account
•Outbound calling to insurance companies as well as Medical Providers to obtain necessary documentation for medical billing submissions
•Apply the correct diagnosis and procedure codes based on documentation and payer specific requirements
•Submit medical claims with/without supporting medical documentation,and appeals to insurance companies for consideration of payment
•Collection settlement negotiations and payments on aged self pay patient accounts
•Kept management informed of billing issues; and other duties as assigned Medical Claims Examiner
Johns Hopkins Healthcare
May 2010 to December 2013
• Process and pay medical claims for Priority Partners, JH EHP, and PAC insurance including COB claims
• Review claims to ensure provider office has billed correctly
• Readjucate and release claims for payment and or deny services appropriately per schedule of benefits Third party pay and chase workers compensation claims processing and payment retractions
• Approving, pending, or denying payment according to the accepted coverage guidelines.
• Identifying and referring all claims with potential third party liability (i.e., . subrogation, COB, MVA, stop loss claims, and potential stop loss files).
• Maintaining internal customer relations by interacting with staff regarding claims issues and research, ensuring accurate and complete claim information, contacting insured or other involved parties for additional or missing information, and updating information to claim file with regard to claims status, questions or claim payments.
Education
Nursing
Baltimore City Community College - Baltimore, MD
January 2006 to January 2007
High school or equivalent
W.E.B. School of Science
September 2002 to June 2005
Skills
• Scheduling
• Billing
• Receptionist
• Data Entry
• Filing
Certifications and Licenses
Licensed Property and Casualty Insurance Adjuster
March 2019
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