Medical Billing Claims Adjuster
Resume:
Virginia Clay
Insurance Professional
Garland, TX 75044
adu7zb@r.postjobfree.com
SKILLS AND EXPERTISE
● Contract negotiation and
Settlement
● Problem solving and
decision making
● Regulatory compliance and
standards
● Process and productivity
improvement
● Organizational administration
and functions
● Time management and
prioritization
● Customer service and
relations
● Guidewire program
● Repair Shops
● High Volume
● Auto Claims
● Review demand packages
● Diary management
● 24 hour contact
● Coverage investigation
● Liability determination
● Escalation Specialist
● Special projects Special Title
Processing
● Communication and
Coordination
EXPERIENCE
Allstate Insurance, Coppell, TX (Remote) - Total Loss Specialist August 2018-Present
● Total loss claims handling experience, including making coverage decisions, customer contact, and rental managements experience is required
● Interpersonal skills to effectively coordinate a prompt, fair, and equitable resolution of all assigned claims
● The ability to work in a fast paced, high-volume environment
● Investigate and resolve first and third party auto physical damage claims by attempting immediate contact to confirm/review coverage
● Investigate damages and maintain control of loss and of use expenses
● Preparation of necessary correspondence to settle total loss claims with insureds, claimants, and their legal representatives and will issue indemnity and expense payments with key initiative on accuracy of settlements
● Knowledge of legal and auto repair/construction terminology Sedgwick Claims, Irving, TX - General Liability Claims August 2017- December 2017
● Responsible for ensuring simple general liability claims are resolved as quickly as possible
● Enter incidents upon receipt and set off investigation with 24 business hours
● Make a request for investigative documentation such as police report numbers, statements, incident reports, photos, videos, and employee records to be able to perform a thorough investigation
● Carry out a review of medical documentation in the case of claims regarding body injuries
● Quickly attend to inquiries through written and phone channels within statutory requirements from insurance carriers, clients, claimants, repair shops, attorneys, appraisers, physicians, and physical damage experts
● Track time frames and set diaries as instructed by statute and regulation and/or as expected by client
● Start up and respond timely to correspondences, including demands and letters of representation from attorneys
● Prepare checks and make a request for client’s settlement authority as part of closing duties
● Send necessary documentation and create correspondence to physicians, insurers, and claimants
● Carry out documentation of claim files; evaluation of potential exposure to legal liability; establishment of appropriate claim reserve; negotiation of fair settlement of claim based on supporting claim documents and thorough investigation
● Evaluate all damages that have been proven, including property damage reports, medical specials, and other relevant supporting documents that have been submitted or requested, to be able to substantiate claims.
● Set up rental through ARMS
Empower Insurance, Dallas, TX - Attorney Rep/Bodily Injury Adjuster March 2017- August 2017
● Investigate & settle coverage/liability/bodily injury auto claims
● Investigate, evaluate, negotiate and authorize settlement of bodily injury and personal injury protection claims within an established time limit.
● Evaluated injury claims, adjusted and prorated special/general damages, and negotiated settlement of bodily injury and property damage claims.
● Reviewed and evaluate demand packets, negotiated bodily injury and property damage claims within authority level with attorneys and claimants
● Respond timely to Stowers demands
Kemper Insurance, Dallas, TX - Claims II Adjuster
September 2016- March 2017
● Investigate, evaluate, and settle insurance claims
● Determine whether the insurance policy covers the loss claimed
● Decide the appropriate amount the insurance company should pay
● Ensure that claims are not fraudulent
● Contact claimants’ doctors or employers to get additional information on questionable claims
● Talk with legal counsel about claims when needed
● Negotiate settlements
● Authorize payments
● Maintain 24 hour contact on daily basis.
● Maintain 100% closing
● Analysis of California claims
ACCC, Dallas, TX - Insurance Claims Adjuster
October 2015- September 2016
● Received claims (work from beginning of case to close)
● 100% Attorney represented files
● Liability analysis for the state of Texas
● Corresponded with client, attorney and medical facility to resolve claim
● Onsite visits to claimant and insured
● Worked in a team environment to resolve claim
● Worked alongside attorney using my expertise of insurance to help the case for the insured
● Total loss claims
● Proficient in determining actual cash values (ACV)
● Claim File Management
● Sent close out letters required by the state
● Total loss claims
National Oilwell Varco, Houston, TX - Quality Control Documentation October 2012- September 2015
● Review Material Test reports received from vendors for chemistry, heat treat, tensile lateral, ensuring that it meets
● spec requirements.
● Assign lot numbers and IPFs
● Documentation
● Worked with Glovia & IHS to approve parts for clearance to ship to rigs.
● Check chemical element mechanicals for balance
Kemper Insurance, Dallas, TX - Senior General Liability Adjuster January 2004- December 2008
● Received claims (work from beginning of case to close)
● Corresponded with client, attorney and medical facility to resolve claim
● Onsite visits to claimant and insured
● Attended mediation
● Worked in a team environment to resolve claim
● Worked alongside attorney using my expertise of insurance to help the case for the insured
● 35% litigated files
● Proficient in determining actual cash values (ACV)
● Claim File Management
● Total loss adjuster- Manage an inventory and negotiate and settle 1st and 3rd party claims in which the
● automobiles have been deemed a total loss.
● Obtain appropriate title documents and guarantee of lien release from lienholders.
● Reviews values and calculates settlement offers.
● Runs Carfax and car title history reports, if applicable.
● Sends and manages written correspondence to policyholders and 3rd party interests.
● Responsible for scheduling vehicle pick-ups and negotiating advance charges with body shops and tow yards.
EDUCATION
02 License 1998 to Present
CE hours 1998 to Present
Texas Adjusters License-Grandfathered
.Remington College Medical Billing & Coding Certificate 2009-2010 GPA: 3.67
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