Claim Specialist

Janyne Collins

**** ****** *** ** *** Acworth, GA 30102

Cell: 770-***-****

*******@***.***

Claim Specialist

Professional Summary

Highly organized and trained Claims Specialist with an excellent history of successful claims management and loss minimization. Creative and independent problem-solver who also coordinates well with management and other company employees. Flexible scheduling availability to cover weekends and emergency situations as required.

Core Qualifications

Extensive experience in claims management and adjusting

Exceptional knowledge of insurance contracts coverages claims management programs and all related medical and legal terminology

Superior ability to interpret and review account statements and histories

Strong grasp of a variety of claim processing rules and guidelines

Excellent skills in analyzing legal documents and medical records

Outstanding proficiency with Microsoft Office applications such as Word Access and Excel

High problem-solving and organizational skills

Proven ability to self-motivate and work independently

Solid written and oral communication skills

Key Skills

Office Skills:

Office Management

Records Management

Database Administration

Spreadsheets/Reports

Event Management

Calendaring

Front-Desk Reception

Executive Support

Travel Coordination

Computer Skills:

MS Word

MS Excel

MS PowerPoint

MS Outlook

MS Access

MS Project

MS Publisher

FileMaker Pro

Windows

Experience

Allstate – Kennesaw, GA Claims Specialist, 2010–2020

Identified and acted on damage mitigation opportunities

Validated all claims completely and accurately.

Utilized appropriate claims tools to assess damages fully and accurately.

Reviewed determined and released reimbursements to various customers.

Performed all work in accordance with customer and company standards.

Carla Miles Collection — Woodstock, GA

Assistant / Partner, 2003-2010

Handled multifaceted clerical tasks (e.g., data entry, filing, records management and billing) as the assistant to the registrar and admissions offices. Coordinated travel arrangements, maintained database and ensured the delivery of premium service to customers. I was a trusted assistant known for “can-do” attitude, flexibility and high-quality work.

Communicated effectively with multiple staff members to plan meetings and prepare for vary types of events. Established strong relationships to gain support and effectively achieve results.

Helped coordinate dozens of recruitment events (average of 12 large gatherings per year) that contributed to consistently high sales.

Entrusted to manage office in the CEO’s absence. Provided timely, courteous and knowledgeable response to information requests; screened and transferred calls; and prepared correspondence.

Co-developed comprehensive, 60-page training manual that enabled faster ramp-up for newly hired support staff.

Earned excellent marks on performance reviews, with citations for excellence in areas including work volume, accuracy and quality; ability to learn and master new concepts; positive work ethic; and commitment to providing unsurpassed service.

Horizon Blue Cross Blue Shield of New Jersey – Newark, NJ

Medical Claim Processor, 1994-2003

Provides plan and claim information, assists with submission of claims, and makes outbound calls to gather missing information on incomplete claims

Participate in the development of policies and procedures to improve department workflow and the claims process ensuring proper documentation

Manage return to work with the Return to Work Coordinator

Provides claim information, assists with submission of claims and makes outbound calls to gather missing information on incomplete claims

Collaboratively work with a network of approved in-house professionals and monitoring the progress of a claim

Advise clients of their claim related obligations under the policy and establish client-specific claims management procedures

Monitors and improves the performance of trading partner’s services for your clients

Education

Phoenix University 2017-present

BS, Criminal Justice

Expected Graduation date May 2021

Rutgers University 1994-1997

BS, Criminal Justice

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