Claims Adjuster Customer Service

PROFILE

Experienced claims

adjuster with

proficiency in

evaluating,

investigating, and

determining liability.

Detail oriented with

strong work ethic

meeting standards of

excellence. Solid

experience with

negotiating settlements

and processing

policyholders claims.

SKILLS

Customer Service

Strategizing

Logical Reasoning

Problem Solving

Deriving Estimations

Poised Under Pressure

EDUCATION

Bronx Community

College

Expected Graduation

Date – July 2023

CONTACTS

(C) 917-***-****

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

1027 Duncan Street

Bronx, NY 10469

ML EXPERIENCE

Claims Adjuster Liberty Mutual Group Uniondale, NY Oct. 2014–Sept. 2021

• Executed negotiation and closing techniques to secure profitable business settlement of claims up to $300,000.

• Coordinated care for payable claims by approving and authorizing treatment, surgery, and medications. Implemented changes and performed user acceptance testing requested by brokers, attorneys, clients, and management.

• Decreased backlog of reported claims (from 1400 unanswered requests for correspondence to 200) within 45 Days.

• Completed full claim assessment to determine coverage eligibility.

• Managed approximately 160 claims, processed, and resolved claims assigned by Claims Team Manager. Evaluated liability and settled claims within prescribed authority.

• Communicated with policyholders, witnesses, and claimants to gather information regarding claims and referred tasks to auxiliary resources as necessary. Responded to various written and telephone inquiries including status reports.

• Confirmed or denied coverage and liability, advised policyholders and claimants as to proper course of action.

• Identified and recommended referral of potentially fraudulent claims to the SIU.

• Triaged litigation matters and made strategy decisions. No-Fault Claims Supervisor Liberty Mutual Group Farmingdale, NY Oct. 2002–Oct. 2014

• Supervised daily activities of eight team members by managing project deliverables and deadline, assigning and monitoring tasks to completion.

• Trained and coached team members to adopt continuous delivery and standard work practices.

• Conducted weekly and monthly reviews and updates on employee performance requirements.

• Collaborated with management teams to rollout new work processes.

• Created spreadsheets to track testing requirements, results, and defects. Presented testing updates and recommendations for enhancements and defect fixes to Senior Management.

• Created new steps and procedures to implement workflow and aid in the medical claims processing.

• Performed quality control review on all claims assigned to team members and provided feedback and recommendation on action plan for claim resolution. Claims Adjuster Liberty Mutual Group Farmingdale, NY Sept. 2000–Oct. 2002

• Created and presented monthly reviews and updates on claim status to senior management.

• Executed negotiation and closing techniques to secure profitable business settlement of claims up to $300,000.

• Coordinated care for payable claims by approving and authorizing treatment, surgery, and medications. Implemented changes and performed user acceptance testing requested by brokers, clients, and management.

• Decreased backlog of reported claims (from 1400 unanswered requests for correspondence to 200) within 45 Days.

• Planned and conducted investigations on over 200 claims (including but not limited to interviewing parties involved collecting, evaluating documentation, securing evidence and protecting the chain-of-custody) to analyze coverage, determine liability, compensability and damages of claims.

• Assessed policy coverage, contacted insured, determined and established reserve requirements.

• Evaluated claims for potential fraud.

• Assessed actual damages associated with claims and conducted negotiations to settle claims. PROFESSIONAL EXPERTISE

• Coding guidelines • CPT/HCPCS • Mitchel pricing system • Guidewire (claims)

• ICD-9 & 10 • Diagnosis coding • MS Office (Excel, PowerPoint, Word)

• Reimbursement Rates Workers

Compensation fee Schedule

MICHELLE LEWIN

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