Claims Adjuster North Carolina

Rosalyn C. Reid

Raleigh, NC *****************@*****.***

Knowledgeable of Personal Lines (e.g., Homeowner, Auto, Health), Commercial (e.g., Property, Auto, Workers’ Compensation), Watercraft, Ocean Marine, Inland Marine, Surety & Fidelity Coverage, Umbrella & Excess Liability

Claims Adjustments & Settlements Fraud, Hazards & Risk Mitigation

Cause & Loss Valuation, Deductibles & Coinsurance Complex Negotiations

Client Relations Process Optimization Escalations Resolution Policy Limits

Common Policy Provisions Liability & Law Document Analysis & Interpretation

Highly Motivated NC Claims Adjuster who is eager to offer newly achieved training and licensure toward handling high-volume claims while obtaining risk-mitigating, cost-effective outcomes to align with a company’s mission and a policyholder’s goals. Top Performer who succeeds in autonomous and/or collaborative work environments, maintains poise in challenging situations, and resolves in-depth issues to attain results.

Ambitious Self-Starter who is recognized as a dependable, honest, punctual, and responsible team player adept at demonstrating strong critical thinking, problem-solving, and conflict resolution skills to ensure a positive customer experience. Articulate Communicator who thrives in rapidly evolving business scenarios to exceed service expectations while continually leading peers by example and with ethics and integrity.

Education & Professional Development

Bachelor of Arts in Broadcast Journalism & Political Science Indiana University Bloomington

Licensed Claims Adjuster (2024) State of North Carolina

All Lines Training Certification AdjusterPro

Also Holds Medical Coding Certifications – CPC/CBCS

Completed Tactical Xactimate Training (e.g., Skilled in Using Sketch)

Completed Construction 101 Training (e.g., Building Materials Estimates, Rooftop Assessments)

Professional Experience

Screening Analyst Parathon, Raleigh, NC 2022 – 2023

Excelled in collaborating among multidisciplinary teams to proactively identify missed reimbursement opportunities, as well as drive process improvements to boost remuneration collections’ efficiency.

Skillfully reviewed complete healthcare revenue cycle systems, including the CDM Charge Description Master. Analyzed legacy systems for accurate DRG, ICD-10 CM, CPT codes, and HCPCS codes.

Optimized data/records management by interpreting and analyzing medical documents, including outpatient reports, ED records, EOBs, payer websites, and insurance contracts, among others.

Medical Insurance Instructor Gwinnett College, Raleigh, NC 2022

Leveraged broad industry knowledge toward monitoring and managing students’ use of tools, resources, and equipment, including providing detailed instruction and role modeling to align with course standards.

Delivered excellence in instruction of academic and practical coding, computer, and English curricula by leading thought-provoking discussions, as well as providing real-life examples to achieve subject mastery.

HCS Medical Coding Supervisor UNC Health Care System, Chapel Hill, NC 2017 – 2022

Demonstrated strong communication and interpersonal relations skills toward actively liaising among physicians, chairs, executive, coding staff, and healthcare teams to ensure proper coding at all times.

Led decision-making efforts for coding in divisions of ENT, neurosurgery, OB/GYN, family medicine, pathology, dermatopathology, and pediatrics, as well as seven (7) urgent care centers and E/M coding.

Ensured compliance with official coding conventions and rules from American Medical Association and Centers for Medicare & Medicaid Services to assign diagnostic, CPT, and HCPCS codes.

Directed three (3) escalated denial workqueues while efficiently planning and monitoring daily workflow for specialized coding staff's daily production, as well as managing PTO time and attendance records.

HCS Medical Coding Supervisor Duke Health System, Durham, NC 2011 – 2017

Directed all facets of HCS medical coding and daily operations of the revenue cycle, including handling coding denials and patient-escalated denial workqueues (e.g., pre-certification, prior authorization).

Mentored and managed a detail-focused team of ED, neurosurgery, ENT, GI, and OB coders while overseeing all hiring, training, and terminations; time and attendance; and/or corrective actions.

Managed two (2) escalated denial workqueues and one (1) patient complaints workqueues, as well as five (5) coding and edit workqueues.

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