Claims Adjuster Customer Service

Katrina Chatmon

United States 469-***-**** *******.*******@*****.***

PROFESSIONAL SUMMARY

Experienced Claims Adjuster with 3 years of Auto Claims experience. Highly familiar with customer relationship management (CRM) systems and software, conflict resolution, and customer escalations. Excited to use my proven skills and customer enthusiasm to bring customer satisfaction efficiently and effectively to all of those I encounter while on the job.

TECHNICAL SUMMARY

O/S: Linux/Unix, Windows, MacOS

ITSM Platforms: Salesforce, Jira, Zendesk, ServiceNow

Claims: Licensed Claims Adjuster, ARMS, Accurint, ISO, ARB (Ehub), Copart

Knowledge & Skills Areas

•SQL

•Business Analysis

•Google Sheets

•Splunk

•Google Suite

•Dashboards

•Trend Analysis

•Cisco

•Slack

PROFESSIONAL EXPERIENCE

EDI Help Desk Tier 2, 4 Consulting 02/2023 – present.

Answering and responding to inbound calls from trading partners

Escalate priority support issues to senior staff and corporate groups.

Handle EDI incidents and requests pertaining to claims and enrollments.

Resolving inquiry email and ensure emails are closed out in the required timeframe.

Prioritize and schedule work as necessary

Respond to inquiries from vendors, payors, providers and trading partners

Tracking all complaint emails according to policy and procedures

Creating and responding to support ticket using service now

Researching denials and rejections

Claims Adjuster, The Jacobson Group 10/21 – 11/2022

Investigating, evaluating determining liability

Determining coverage for policies

Opening and closing reserves once payments have completed to all parties.

Confirming if claims are fraudulent or not.

Administering recorded interviews for all parties to determine liability.

Conferring with legal counsel when needed

Determining total loss and reviewing total loss settlements with applicable parties

Negotiating settlements for total loss

Managing bulk claims to bring them to closure in a timely manner.

Claims Adjuster, Geico 8/19 - 8/2021

Determining liability and advising of coverages.

Administering recorded interviews for all parties to determine liability.

Recognizing questionable coverage conditions and applying thorough investigations to determine coverage.

Negotiating settlements with third parties including attorney represented

Providing customer service and promoting seamless interactions to bring claims to closure.

Adhering to company standards and maintaining metrics

EDI Onboarding, XPO Logistics 12/2017- 3/2019

Establish operation strategy in a team environment to improve Onboarding structure.

Prepare data and information for making regular report data analysis.

Perform data analysis for complex data and files.

Assist with Mapping and testing.

Project coordinating with team members across the board using Jira and Gentran.

Drove financial performance of assigned area by onboarding clients via EDI process for testing.

Claims Adjuster,, United Healthcare 3/2017- 10/2017

●Investigate medical claims.

●Determining claims compensation using state business and regulations

●Ensured timely conversion for each claim submitted.

Customer Support, AT&T 3/2013- 3/2015

●Analyze and process customer information.

●Process payments and troubleshooting devices.

●Determine fraudulent activities.

●Assist resolutions team with unresolved account issues.

●Adhere to schedule and metrics as required.

EDUCATION

AIU Online 01/2010

Associate of Arts Degree in Business Administration, AIU Online

Associate of Business Administration

Google Certification / Coursera 12/12

Introduction to Data Analytics

Health Information technology Fundamentals

Critical Role of IT Support Staff in Healthcare

Project Management (Currently enrolled)

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