Customer Service Claims Adjuster

LARRY WILLIAMSON

404-***-**** *****************@*****.***

PROFESSIONAL SUMMARY

Claims Adjuster with over 5years experience in the insurance industry, specializing in auto and property claims. Successfully managed a portfolio of 500 plus claims annually, achieving a 98% customer satisfaction rate. Demonstrated expertise in negotiation and settlement agreements, with outstanding customer service rating.

WORK EXPERIENCE

SKILLS

CCC

Vehicle Inspections

Negotiation

Mitchell

Liability Claims

Injury Claims

Strong Customer Service

Total Loss and Evaluation

State Laws

State Farm Certified

Policy Coverage

Issuing Payments

Microsoft Office

WORK HISTOR

Auto Field Adjuster Allstate Atlanta

Evaluated, reviewed auto claims.

Completed scope of damages and wrote estimates using CCC and Mitchell

Reviewed and wrote accurate estimates.

Handled Insured and third-party auto, motorcycle, RV, and trailer total loss claims; Negotiated payments; Traveled to designated Repair Facilities and Members Home.

Worked in the field and remote; Handled virtual and photo assist claims.

Worked all weather claims while deployed

Evaluated and condition vehicles for Total Lost

Field/Deployed Auto Adjuster State Farm

Utilized my ability to effectively communicate with claimants, insured, repair facilities, employers, and government agencies through both written and verbal communication.

Created and evaluated scope of damage estimates using CCC and Mitchell software.

Coordinated communications with supplier and repair facilities on OEM or aftermarket and used parts.

Worked catastrophe claims as field and deployed adjuster.

Worked photo and live video estimates with repair facility and insured.

Worked total loss.

Body Repair Adjuster/Drake Repairs

Researching automotive parts and supplies to create accurate cost estimates

Reviewing repair orders and inspecting damaged vehicles to identify repair needs

Calculating costs associated with the repair of damaged vehicles

Creating detailed estimates for the cost of labor, parts, and other services related to collision repair

Preparing estimates for approval by customers

Negotiating pricing terms with suppliers

Providing customers with updates on their repairs

Maintaining records of estimated and actual repair costs

Revenue Cycle Manager/Supervisor Pediatric Partners

Managed a staff of 15.

Facilitated recruitment and hiring of AR Specialist

Provided coaching and development of AR staff as it relates to claims.

Administered disciplinary action as needed (PIP, warnings, etc.)

Ensured direct reports have clear targets/benchmarks of what is expected.

Pre-claim review/Scrub Review all claims from billing department before they are dropped to Payer.

Followed the process of all claims submitted to All Payers (Government/Commercial) once EDI has been performed.

Determined appropriate staffing levels for the department.

Attended client onboarding calls and implementations.

Fostered an environment of cooperation and change.

Followed up on all denial claims for all denial reasons by reviewing bucket status from 120 and greater to 31 days.

Claims Analyst Prospira

Analyzed each claim to make sure that they followed proper guidelines and procedures.

Responsible for filing each claim and keeping the archive accessible throughout claim duration.

Prepared monthly reports for management on the status of all outstanding and paid claims.

Followed up on all denied claims for correction and solutions for prompt payments and adjustments.

Reviewed out of balance claims for correct posting and adjustment.

Wrote appeals by reviewing all medical records from provider for a higher percentage for reversal of claims that was denied for experimental or non-medically necessary.

Claims Specialist & Customer Service Alliance Spine and Pain

Ensured services were accurately billed and collected in a timely manner.

Ensured revenue cycle practices and procedures were compliant with applicable payer requirements, laws, and regulations.

Communicated identified trends that impacted cash collections negatively to management.

Initiated appeals and ensured all required documentation were submitted in the appeals process.

Critically reviewed existing AR processes to initiate and drive changes that led to best practices.

Researched all denials and followed up as necessary.

Drove standardization of revenue cycle practices across the entire AR team by partnering with other Billing & Collections Managers

Improved department efficiency by promoting and implementing exception-driven actions, follow-up, reporting, and management.

Collaborated with leadership on AR related issues to ensure their AR is kept at the lowest possible levels and that root-cause issues are identified and corrected.

Reviewed adjustments for accuracy and timely processing

HEDIS

EDUCATION

University of Alabama

Mattie T. Blount High School

STATES LICENSED

Georgia (State Farm Certified Auto Adjuster)

Alabama

Louisiana

Florida (Resident/All Lines)

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