Post Job Free

Resume

Sign in

Customer Service Claims Adjuster

Location:
Cary, NC, 27518
Posted:
April 17, 2023

Contact this candidate

Resume:

JUNE A SIMBA

Creedmoor, NC *****

1-713-***-**** - adwlcl@r.postjobfree.com

PROFESSIONAL SUMMARY

** ***** (My entire life) of family military experience, 18 years of Government professional service working directly with retirees and servicemen/women. I am spouse of a wounded veteran who served his time honorably, through multiple wars and daughter of a Colonel, I have VA experience that cannot be captured in a resume on paper but is applied daily in real life and daily work life skill. My Husband and I have founded 2 NGO's, an International Foundation and a Military Fraternity that serves the needs of the underserved communities nationwide. I have experience in Federal, State and City Government and my husband is currently a GS13. The level of mature experience, non-certificated education and professional skill & intend on applying to daily duties are vast, deliver consistent efficacy/results and meticulous. As a current mortgage broker my FBI & Financial credentials are and have to remain top notch. I hold various Federal Financial Licenses.

SKILLS

Loan Counseling

Key Account Generation

Organizational Strengths

Electronic Health Records

Reserve Management

Microsoft Dynamics

HIPAA

Scrupulous Records Management

Prospecting Clients

Meeting Preparation

Legal Compliance

File and Records Management

Community Reinvestment Act

COBAL Expertise

Networking and Partnership

Development

Fraudulent Claims Investigation

WORK HISTORY

08/2022 to Current Sr. Mortgage Office

Triangle Lending Group – Raleigh, NC

Supervised loan personnel and motivated to maintain customer service and performance standards.

Fielded customer complaints and provided solutions. Developed and maintained relationships with customers, lenders and other third parties.

Analyzed potential risks and evaluated loan products to identify suitable options for customers.

Negotiated loan terms and conditions with customers to secure best deal. Researched and updated industry knowledge on changing legislation and regulations.

Explained very technical financial information to applicants in easy to understand language.

Developed and implemented marketing campaigns to generate new business opportunities.

Checked loan documents for accuracy prior to closing. Contracted by City of Raleigh & Town, UNC & of Wake Forest to provide public

& broadcasted educational seminars/classes.

Approved loan applications based on customer creditworthiness and provided detailed financial advice.

Processed loan applications and monitored progress from start to finish. Communicated with clients, processing teams and other third parties to achieve prompt loan closings.

Assisted clients in selecting correct loan product and terms to meet needs and financial goals.

Developed extensive network of referral partners to source new mortgage loan opportunities.

Participated in industry events and conferences to build relationships and gain market intelligence.

Reviewed loan files and updated to match current standards. 02/2020 to 10/2022 Owner/Operator

Wake Care Medical Transportation LLC – Creedmoor, NC Oversee transportation department, including its assets and employees for our 4 ambulatory vehicle fleet.

Secured 8 Contracts with Medicaid/Medicare, Private Insurance Providers, Workers Comp contractors, VTS & Accident Law firms in NC Medical billing & Client Reimbursements - Knowledge of all forms/portal use & trained staff

Established procedures for custody and control of assets, records, loan collateral and securities to ensure safekeeping.

Compiled financial reports pertaining to cash receipts, expenditures and profit and loss.

Manages the operational aspects of ongoing projects and serves as liaison between project management and planning.

Preparing and completing action plans, implementing production, productivity, quality, customer service standards, and resolving problems. Completing audits; summarizing data and identifying trends; determining transportation system improvements, and implementing change. Meets financial objectives by forecasting requirements; preparing an annual budget; scheduling expenditures; analyzing variances; initiating corrective actions. Review plans for and provision of logistical support for probability, efficiency, and economy, and to develop changes when required.

Proactively plans ahead to increase efficiency through more effective staffing, equipment and supply utilization, service delivery and recovery, employee training and development, budgeting, departmental organization, communication with subordinates and other employees, and anticipation of service problems. Filed and addressed employee complaints in accordance with company policies and government regulations.

Performed statistical analyses to gather data for operational and forecast team needs.

Developed and implemented marketing strategies to generate new customers and increase sales and profit margins.

Established, optimized and enforced business policies to maintain consistency across industry operations.

Transported patients to assigned medical facilities, enabling secure delivery to appropriate departments.

Earned and maintained necessary certifications.

Took active role in patient and family planning process, detailing instructions, and responding appropriately and effectively to questions and concerns. Reviewed and requested medical records, military personnel records and service verification records to determine eligibility status. Assisted veterans and dependents in preparing forms and documents to present claims for benefits.

Coordinated with different service providers to meet clients' individual needs. Helped clients navigate social services system and access needed resources. Maintained internal database of service workers, participants, activities and other relevant details.

Intervened in crisis situations to obtain support for clients and reduce escalation or recurrence risks.

Tracked service activities and outcomes against outlined plans and goals. 02/2020 to 06/2023 Mortgage Loan Originator

Equity Smart Home Loans – 1499 Huntington Dr Suite 500, S Pasadena, CA 91030 Developed and maintained relationships with customers, lenders and other third parties.

Worked with underwriters to fix application problems and resolve issues. Followed up with clients on missing loan documents, providing guidance on best way to complete application process.

Negotiated loan terms and conditions with customers to secure best deal. Analyzed potential risks and evaluated loan products to identify suitable options for customers.

Explained very technical financial information to applicants in easy to understand language.

Analyzed loan applications and credit reports to determine loan eligibility and risk level.

Calculated debt-to-income ratios to determine maximum loan amounts and avoid overextending applicants.

Prepared loan documents and explained terms to clarify loan conditions and requirements with applicants.

Verified credit histories, personal references and employment backgrounds for each applicant.

Reviewed loan files and updated to match current standards. Tracked loan status and updated applicant information to inform lenders of changes to applicants' financial situation.

Calculated, reviewed and corrected errors on interest, principal and closing costs. Set up, stored and updated customer files, department records and regulatory paperwork.

Monitored portfolio performance and provided clients with periodic updates on loan progress.

Fielded customer complaints and provided solutions. Stayed up to date on loan regulation changes, processing loan applications in compliance with current laws.

Affirmed loan document accuracy to protect lenders from potential fraud. Participated in industry events and conferences to build relationships and gain market intelligence.

Contacted customers via mail, telephone and email to relay acceptance or rejection of applications.

Liaised with credit bureaus, employers and other sources to check applicants' credit and personal references.

Negotiated loan terms and conditions with clients to maximize profitability. Readied Truth-in-Lending Disclosures for loan applicants, delivering important information about loan APR and repayment terms.

Collected and compiled paperwork such as title abstracts, insurance paperwork, loan files and tax histories.

Communicated with clients, processing teams and other third parties to achieve prompt loan closings.

Analyzed credit reports to assess risk and determine applicants' ability to repay loans.

Provided professional advice on loan applications by interviewing applicants, reviewing applications and verifying information gathered. Maintained high level of customer satisfaction by providing prompt and accurate loan status updates.

Consulted with outside vendors to identify and resolve loan closing issues. Interviewed loan applicants to obtain personal and financial data to assist in completing applications.

Developed and implemented marketing campaigns to generate new business opportunities.

Assisted clients in selecting correct loan product and terms to meet needs and financial goals.

Explained different types of loans pertaining to client situations. Communicated acceptance or rejection to applicants via mail, email, telephone or personal consultations.

Reviewed and validated details of loan applications and closing documentation. 08/2004 to 09/2021 Procurement & Contracting Specialist Virginia Department Of Environmental Quality – 1111 E Main St Suite 1400, Richmond, VA 23219

Communicated regularly with suppliers to uphold accountability for quality standards and timely delivery of goods.

Created purchasing policies and procedures that complied with company standards and regulatory requirements.

Utilized procurement tools to manage quote process, invoicing, order entry and receiving.

Hired and trained purchasing staff to improve effectiveness of purchasing operations.

Resolved daily issues by handling invoice discrepancies, replacements for rejected materials and missed and late deliveries.

Monitored inventory levels and avoided shortages with timely replenishment of stock.

Researched and evaluated potential suppliers to determine best fits for company needs and to identify cost savings opportunities.

Identified opportunities to reduce lead times and improve inventory management. Analyzed market and delivery systems to assess present and future materials availability.

Devised and implemented strategies to optimize purchasing processes and reduce costs.

Negotiated pricing and terms with vendors to secure best value for company. Facilitated resolution of vendor disputes and discrepancies. Collaborated with internal stakeholders to create timely and accurate purchase orders.

Developed and tracked metrics to measure supplier performance and cost savings. Reviewed and approved purchase orders and invoices for accuracy and completeness.

Cultivated strong relationships with vendors to maintain and improve levels of customer service.

Researched and evaluated new and current vendors to determine suitability of products and contract and pricing negotiations.

Managed procurement requests and acted as point-person for customers on logistics, hardware and software needs.

Established and maintained accurate records of purchases, pricing and payment terms.

Reduced costs by streamlining contract bidding and procurement processes to assure best prices for materials and services.

Completed monthly profit and loss performance reports. Generated reports on purchasing activities to support management decisions. Paralegal & Business Executive Administrative duties as assigned in absence of Director.

01/2002 to 05/2004 Medical Claims Adjuster & Insurance Manager AON – Headquarters At 122 Leadenhall Street, London Collected medical information from customers to complete claims and legal files. Prepared administrative records/documents for managers or legal personnel. Reviewed provider coding information to report services and verify correctness. Identified and resolved discrepancies between patient information and claims data. Determined liability outlined in coverage and assessed documentation such from police and healthcare providers to understand damages incurred. Maintained suspicious claims database and prepared reports for supervisors. Incorporated [Type] objectives to achieve action plans and strategies. Maintained contact with claimants and attorneys to determine treatment status. Analyzed information gathered by investigation and report findings and recommendations.

Researched claims and incident information to deliver solutions and resolve problems.

Identified suspicious losses and contacted manager for investigative assistance. Followed up on potentially fraudulent claims initiated by claims representatives. Investigated and assessed damage to property and reviewed property damage estimates.

Responded to correspondence from insurance companies. Interviewed agents and claimants to correct errors or omissions and investigate questionable claims.

Read over insurance policies to ascertain levels of coverage and determine whether claims would receive approvals or denials.

Delivered exceptional customer service to policyholders by communicating important information and patiently listening to issues. Maintained claims data in [Type] systems.

Analyzed information gathered by investigation and reported findings and recommendations.

Identified insurance coverage limitations with thorough examinations of claims documentation and related records.

Synthesized data into comprehensive quarterly written reports for management. Reviewed and analyzed suspicious and potentially fraudulent insurance claims. Worked with private investigators and attorneys on preparation of evidence, witness statements and other documentation in preparation for trial. Clarified coverage of losses to policyholders and provided assistance in itemizing damages and finding alternative living arrangements. Managed large volume of medical claims on daily basis. Evaluated original investigation reports and documents to resolve secondary concerns.

Established productive working relationships with public officials and law enforcement officers.

Resolved complex, severe exposure claims using high service oriented file handling.

Followed up on denied claims to verify timely patient payment and resolution. Paid or denied medical claims based upon established claims processing criteria. Conducted day-to-day administrative tasks to maintain information files and process paperwork.

Examined claims forms and other records to determine insurance coverage. Reviewed questionable claims by conducting agent and claimant interviews to correct omissions and errors.

Used administrative guidelines as resource or to answer questions when processing medical claims.

Maintained knowledge of benefits claim processing, claims principles, medical terminology, and procedures and HIPAA regulations. Directed claims negotiations within allowable limit of $[Amount] and supported successful litigations for advanced issues.

Directed and coordinated various investigations conducted by field investigation team.

02/2000 to 03/2002 Financial Advisor

Prudential Financial – 1233 West Loop S Ste 1100, Houston, TX 77027 Researched and evaluated potential investment products for clients. Developed and maintained strong relationships with clients to maximize satisfaction.

Studied financial documents to identify potential areas needing improvement. Updated clients on changes in tax laws and other regulations affecting investments. Cultivated and strengthened relationships with new clients and educated clients on account services and capabilities.

Facilitated presentation and recommendation of services by optimizing client relationships.

Provided specialized financial planning support for clients with diverse portfolios and individual needs.

Helped individuals and families build and execute wealth management strategies based on unique goals and objectives.

Researched current economic trends and investment opportunities to stay abreast of financial markets.

Educated clients on financial topics and best practices. Helped clients make informed decisions about financial future. Facilitated new client onboarding process and investment account setup. Analyzed financial needs of clients and developed tailored strategies to meet goals. Assisted clients with preparing financial plans, conducting investment research, and completing trades and transactions to assess and meet financial goals. Advised clients on investments, retirement and estate planning. Educated clients on various financial matters and provided professional recommendations on investment opportunities, products, and services based on each clients' individual needs.

Recruited, trained and mentored junior financial and support staff to generate ideas, share knowledge and grow firm.

Monitored and updated financial plans to comply with client goals. Assisted clients with estate planning to organize distribution of assets based on client wishes.

Developed comprehensive retirement planning strategies to help clients maximize retirement savings.

Assisted clients with budgeting and cash flow management. Presented financial plans and investment recommendations to clients. Devised comprehensive financial plans for clients to achieve short and long-term financial goals.

Educated clients on various financial matters and provided professional recommendations on investment opportunities, products and services based on individual needs.

Implemented exit strategies for clients to transition out of investments. Collaborated with clients to develop customized investment portfolios. Developed personal rapport with each client to maintain customer loyalty and establish long-term accounts.

Met with clients to discuss assets, expenses, and long-term and short-term investment goals to devise personalized financial plans. Created financial models to analyze and evaluate investment strategies. Educated clients on potential risks and rewards associated with various investments.

EDUCATION

Associate of Applied Science: Paralegal Studies

J. Sargeant Reynolds Community College - 1651 E Parham Rd, Richmond, VA 23228

06/1995 Associate of Science: Business Information Technology University of London - Senate House, Malet St, London WC1E 7HU, UK LANGUAGES

French

Professional Working

German

Professional Working

Swahili

Professional Working



Contact this candidate