DB

DANIEL BYNUM

adydd3@r.postjobfree.com 214-***-**** Princeton, Texas 75407

Analytical Claims Specialist with proven experience investigating and resolving property, health and business claims. Delivers professional and balanced customer service and meets needs of insured, claimant and internal and external customers. Insurance expert with exceptional knowledge of legal liabilities and claims practices and superior interpersonal skills. Friendly Insurance Verification Specialist promoting a background in keeping sensitive patient data confidential while maintaining knowledge of Medicaid and private policy benefits. Possessing great relationship building and communication skills. Looking to tackle new challenges with a company that values dynamic skills and a strong work ethic. Highly-motivated employee with desire to take on new challenges. Strong worth ethic, adaptability and exceptional interpersonal skills. Adept at working effectively unsupervised and quickly mastering new skills. Settlement Determinations

Accident Investigations

Documentation Review

Coverage Assessments

Problem-Solving

Insurance Claim Forms Review

Small Claims Payouts

Data Entry

Customer Service

Coverage Determination

Teamwork and Collaboration

Premium Collection

Information Verification

New Policies Processing

Claim Amount Calculations

Client Interviews

Verbal and Written Communication

Appointment Scheduling

Decision Making

Microsoft Office

Critical Thinking

Cancellation Notifications

Attention to Detail

Time Management

Payment and Investigation Escalations

State Farm Richardson, TX

Claims Specialist

07/2013 - 06/2023

Maintained knowledge of policies and procedures and insurance coverage benefit levels, eligibility systems and verification processes. Communicated with other departments to establish action plans and manage open claims to closure.

Planned and conducted investigations of claims to confirm coverage and compensability.

Resolved claims by approving or denying documentation, calculating benefits due and determining compensation settlement. Documented specific claims by completing and recording forms, reports and logs.

Investigated and analyzed requirements to improve timeliness of reports to customers.

Assessed and conducted negotiations within authority limits to settle claims.

Established proof of loss by studying documentation and assembling additional information from outside sources.

Summary

Skills

Experience

Researched and reviewed information to determine validity of insurance claims and contacted companies and customers about decisions. Determined covered insurance losses by studying provisions of policies or certificates.

Provided legal support by assembling documentation for settlement action. Drafted statements of loss to summarize damages, payments and underlying policy coverages.

Conducted interviews with involved claims parties and witnesses to gather detailed information and arrange investigations.

Oversaw regulatory and strategic initiatives to ensure accuracy of medical claims.

Contacted injured parties and legal representatives to negotiate final settlements for claims.

Used skills to establish productive working relationships with car dealers, loan processors and community business partners.

Examined claims, records and procedures to grant approval of coverage. Mt Olive Church of Plano Plano, TX

Preschool Assistant Teacher

10/2011 - 07/2013

Maintained safe, educational environment for students during learning and free play time.

Interacted positively with children to encourage development and involvement in activities, treating each child with dignity and respect. Assisted teacher with enrichment activities, correcting papers or supervising classroom to foster positive learning environment Worked with students to reinforce learning of material or skill introduced by teacher.

Created calm and disciplined classroom environment to improve student focus.

Supported and documented student growth and progress to achieve academic, social and emotional goals.

Sonics Drive In Plano, TX

General Manager

05/2005 - 09/2011

Trained employees on duties, policies and procedures. Recruited, interviewed and hired qualified staff for open positions. Created schedules and monitored payroll to remain within budget. Supervised employees through planning, assignments and direction. Recruited, trained and empowered employees to achieve key performance indicators.

Tracked monthly sales to generate reports for business development planning.

Administered employee discipline through verbal and written warnings. Managed inventory levels and conducted corrective action planning to minimize long-term costs.

Guided management and supervisory staff to promote smooth operations. Conducted employee evaluations to provide adequate feedback and recognize quality performance.

Led employee evaluations with constructive feedback to boost performance.

Built and maintained loyal, long-term customer relationships through effective account management.

Delivered exceptional client experiences through hands-on leadership of associates and managers.

Directed safety operations and maintained clean work environment to adhere to FDA and OSHA requirements.

Complied with company policies and government regulations to prevent and detect rule violations and protect organization from fines and lawsuits. Designed sales and service strategies to improve revenue and retention. Amberton University Garland, TX

MBA in Business Administration And Management

08/2022

Amberton University Garland, TX

BBA in Business Administration

08/2019

Education and Training

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