Customer Service Delivery
Resume:
DAMIEN BUCHANAN
Email: ********.*********@*****.*** Mobile: 781-***-**** Atlanta, GA
CAREER PROFILE: A dynamic and motivated professional with the background and proven work ethic to guide and support claims adjusting, customer service delivery, and administrative operations. A dedicated team member is known for building rapport and trust-based relationships with clients, with the skill set to analyze and interpret complex information, produce accurate estimations and calculations, maintain detailed and accurate documentation, and convey information to diverse individuals in a clear and accessible manner. Out-of-the-box thinker who is comfortable working in teams or independently to ensure solutions consistently meet or exceed business goals—exceptional interpersonal communication, problem-solving, and policy interpretation skills. CORE COMPETENCIES
• Daily & CAT Claims Adjusting
• Claim Investigations
• File Review
• Documentation & Reporting
• Customer Service Delivery
• Administrative Support
• Policy Interpretation
• Insurance Policies
• Issue Resolution
PROFESSIONAL EXPERIENCE
CITIZENS USAA ALLSTATE HORACE MANN STILLWATER PROGRESSIVE MARKEL NARRAGANSETT BAY SWYFFT, FIELD/REMOTE, JUNE 2022 TO PRESENT
DAILY CLAIMS ADJUSTER, JUNE 2022 TO PRESENT
• Customer Service Excellence: Provide empathetic and responsive service to policyholders, addressing their concerns and questions throughout the claims process to ensure a positive experience.
• Field Inspections: Conduct thorough on-site evaluations of damage caused by various incidents, including fires, windstorms, water damage, pipe freezes, hail, and vandalism, to assess the extent of losses accurately.
• Policy Understanding: Use in-depth knowledge of insurance policies to interpret coverage terms and conditions and ensure that claims are processed by the policyholder's benefits and according to carrier guidelines.
• Timely Claims Processing: Prioritize efficient and prompt handling of claims, ensuring that documentation, inspections, and communications are completed promptly to facilitate swift resolutions for clients.
• Collaboration with Stakeholders: Work closely with contractors, appraisers, and other professionals to gather necessary information and expedite the claims process, fostering a team-oriented approach to claims management. CAT CLAIMS ADJUSTER, OCT 2022 TO PRESENT
• Spearheaded daily claims adjustment processes, managing high-stakes claims for catastrophic events, including Hurricanes Ian, Nicole, Beryl, Helene, and Milton ensuring timely resolution and compliance with regulatory standards.
• Directed comprehensive investigations to drive accurate claim determinations by conducting interviews, performing site inspections, and analyzing critical evidence.
• Evaluated accident reports, police documentation, and supporting materials to substantiate findings and ensure fair claim settlements.
• Developed precise cost assessments for personal and property damages, delivering detailed, actionable estimates to stakeholders.
• Interpreted complex insurance policies to accurately assess coverage scope and mitigate company liability, enhancing decision-making efficiency.
• Excelled in dynamic, high-pressure environments, consistently meeting tight deadlines while managing shifting priorities.
• Trained, mentored, and coached new hires, instilling best practices in claims adjustment, resulting in improved team proficiency and operational excellence.
LIBERTY MUTUAL, REMOTE, DEC 2022 TO NOV 2023
DESK ADJUSTER/FILE REVIEWER/SUPPLEMENTAL ADJUSTER
• Complied with strict protocols and procedures while performing desk adjusting and file review activities.
• Submitted indemnity payments to policyholders, and paid invoices to associated vendors. D
DAMIEN BUCHANAN Page 2
• Made coverage decisions based on the policyholder’s policy, endorsements, and exclusions.
• Drove continuous improvement by identifying process inefficiencies and implementing streamlined solutions.
• Conducted timely follow-up calls with claimants to provide updates, clarify any outstanding issues, and ensure that all necessary information was gathered for a smooth claims process.
• Work closely with vendors, public adjusters, and attorneys to coordinate efforts, share relevant information, and resolve complex claims, enhancing the overall claims management process.
• Established trust-based relationships with clients throughout the claim’s investigation process.
• Participated in training and professional development opportunities to expand skills continuously.
• Navigated complex challenges, obstacles, and issues with an innovative and solution-focused mindset.
• Assessed claim-related documentation, including reaching policyholders and other stakeholders to gather information.
• Calculated and communicated coverage and settlement amounts to policyholders.
• Exhibited expertise in delivering high-quality results with minimal supervision.
• Collaborated with field estimates to ensure carrier guidelines, repair of scope, and building codes were met. TOWER HILL, REMOTE, DEC 2022 TO NOV 2023
DESK ADJUSTER/FILE REVIEWER
• Assessed claim-related documentation, including reaching policyholders and other stakeholders to gather information.
• Calculated and communicated coverage and settlement amounts to policyholders.
• Displayed a friendly and professional demeanor during all client interactions.
• Exhibited expertise in delivering high-quality results with minimal supervision.
• Submitted indemnity payments to policyholders, and paid invoices to associated vendors.
• Made coverage decisions based on the policyholder’s policy, endorsements, and exclusions.
• Demonstrated a strong understanding of insurance policy language to effectively interpret coverage, ensuring accurate claims assessment and clear communication with policyholders.
• Conducted timely follow-up calls with claimants to provide updates, clarify any outstanding issues, and ensure that all necessary information was gathered for a smooth claims process.
• Ensure that all required documentation is collected, organized, and submitted promptly, maintaining thorough records to support decisions and facilitate efficient processing.
• Work closely with vendors, public adjusters, and attorneys to coordinate efforts, share relevant information, and resolve complex claims, enhancing the overall claims management process. MASS EYE AND EAR, BOSTON, MA, JAN 2020 TO JUNE 2022 ADMINISTRATIVE/MEDICAL ASSISTANT II
• Coordinated and scheduled candidate interviews in collaboration with the internal executive search team.
• Maintained a strong focus on data integrity and security while gathering, documenting, and analyzing data for reporting, budget preparation, charts, presentations, and other purposes.
• Fostered and maintained collaborative working relationships with team members.
• Handled administrative responsibilities for department leadership/teams and patients, such as responding to routine and confidential inquiries, collecting payments for cosmetic surgeries, coordinating meetings and travel, scheduling patients, and facilitating check-in/check-out processes.
• Mitigated risks by educating patients on COVID-19 requirements and performing COVID-19 screening.
• Prioritized exceptional customer service while reaching patients to gather information on PPG eCheck-In questionnaires and address patient medical inquiries and prescription requests.
• Assumed additional responsibilities to provide coverage to clinics as needed.
• Ensured transparent and consistent communication with the physician by participating in biweekly meetings. ST. ELIZABETH’S MEDICAL CENTER, BRIGHTON, MA, FEB 2019 TO OCT 2019 ADMINISTRATIVE/MEDICAL ASSISTANT/PATIENT ACCESS COORDINATOR/BED PLACEMENT, APR 2019 TO OCT 2019
• Verified the accuracy of EMR medication lists before final review by practitioners.
• Triaged patients based on urgency, location, room availability, and hospital needs; managed competing priorities.
• Built rapport and positive relationships with patients while taking vital signs/height/weight, assisting physicians, providing escorts to ancillary services, communicating information and delays, and bridging communications with staff. DAMIEN BUCHANAN Page 3
• Accurately prepared test, service and appointment orders while updating medical record (MR) information to ensure correct billing.
• Adhered to strict quality standards while performing point-of-care testing, including lab tests and specimen collection.
• Generated system reports and WQs to open surgical and medical accounts for patients; assisted with patient admission and registration, including check-in, information and insurance verification, scheduling, co-payment and fund collection and documentation, and referral information collection; scheduled diagnostic studies and communicated results.
• Tasked with maintaining a professional and organized waiting room environment, including stocking materials and forms.
• Received and triaged incoming calls for thoracic surgeons and physician assistants; took and conveyed messages. PATIENT ACCESS COORDINATOR/ED REGISTRAR, FEB 2019 TO SEPT 2019
• Liaised with the corporate accountant to prepare monthly revenue spreadsheets.
• Orchestrated patient registration processes, including acquiring treatment consent, obtaining payer compliance forms, copying and scanning patient insurance cards, verifying insurance, collecting payments, and updating data for billing.
• Leveraged strong interpersonal communication skills to provide best-in-class customer service; managed phone lines.
• Mitigated risks by upholding compliance with all internal and external requirements.
• Engaged in routine meetings and training sessions to strengthen knowledge of business priorities and best practices.
• Managed logistics for incoming and expected transfer patients from other facilities. ALLIED UNIVERSAL SECURITY, BOSTON, MA, OCT 2019 TO JUNE 2024 NORTHEAST SECURITY, BOSTON, MA, JAN 2017 TO MAR 2019 SECURITY GUARD
• Entrusted with maintaining a safe and secure environment by monitoring employee/visitor entrance and departure, conducting property controls to proactively identify issues and suspicious behavior, confronting unauthorized personnel, responding to alarms and requests for help, viewing electronic monitoring systems, and enforcing laws and regulations.
• Planned and performed fire and security system tests and inspections to ensure proper functionality.
• Produced detailed written reports outlining daily activities, observations, and incidents to ensure transparency.
• Implemented measures to protect property and people from theft, damage, trespassing, and accidents.
• Collaborated with law enforcement agencies and other authorities as needed. TUFTS MEDICAL CENTER, BOSTON, MA, OCT 2016 TO DEC 2019 PATIENT ACCESS COORDINATOR/REFERRALS/PRECERTIFICATION
• Demonstrated success communicating with diverse individuals daily, including reaching insurance companies for eligibility verification, responding to general phone calls and patient requests, and engaging with colleagues, patients, referring physicians, and other individuals; ensured a strong focus on high-quality customer service delivery.
• Strengthened team knowledge of regulatory compliance by conducting training on HIPAA and other protocols.
• Completed patient registrations accurately and efficiently, including verifying demographic information and maintaining documentation; assisted with revenue cycle clearance.
• Conveyed information to clinical specialists, including patient referral needs and clinical information.
• Contributed to delivering seamless patient experiences by continuously monitoring patient flow and proactively identifying and communicating delays.
• Identified and capitalized on opportunities to maximize hospital and physician reimbursement.
• Cultivated collaborative working relationships with cultural and community resource service providers to expand patient access to important resources.
• Advocated for patient needs and priorities while communicating with physicians and insurance carriers. RESOLUTE PAIN SOLUTION, PORT ST. LUCIE, FL, OCT 2015 TO OCT 2016 MEDICAL RECORDS CLERK
• Gathered, documented, and verified the accuracy of patient medical information in collaboration with team members.
• Responded to medical record requests while ensuring adherence to HIPAA regulations.
• Aided in successfully executing day-to-day administrative operations, such as patient chart management, billing requests, record mailing/logging, scanning, payment collection, inquiry response, chart processing and location, and chart delivery in line with established protocols and procedures.
EDUCATION AND CREDENTIALS
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COURSEWORK IN BUSINESS ADMINISTRATION
Bunker Hill Community College, Boston, MA, 2018 to 2019 Florida Agricultural & Mechanical University, Tallahassee, FL, 2010 to 2015 CERTIFICATIONS AND TRAINING
• Claims Licenses: IN (3799992), FL (W867876), LA (991080), MI (20352052), KY (1212277), OK 300-***-****), TX (2865053), GA (3529668), MN (4080305)
• Xactimate Level I & Level III Certifications
• Symbility/CoreLogic USAA Certification
• State Farm Fire Certification
• Auto Farm Estimatics HAAG Certification
• Wind/Hail Certification
• TWIA/TFPA Certification
• LPCIC Certification
ADDITIONAL INFORMATION
Technical Proficiencies: Microsoft Office Suite (Word, PowerPoint, Excel), Meditech, OnTrac, Revenue Protect, One Source
(Passport), nThrive, Xactimate, XaxtAnalysis, Symbility/CoreLogic, Guide Wire.
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