Customer Service Claims Adjuster
Resume:
Written & Verbal Communication
Appeals & Denial Management
Customer Service & Advocacy
Assisted adjusters with administrative claim tasks and policyholder communication. Uploaded and organized claim documentation, updated policy records, and supported appeals processes. Handled policyholder disputes and escalations with professionalism and accuracy. Detail-oriented and licensed insurance adjuster with 5+ years of experience handling residential property, auto, and workers' compensation claims. Proven ability to investigate losses, assess damages, interpret policy coverage, and negotiate fair settlements in fast-paced remote environments. Skilled in utilizing Xactimate, CMS, and proprietary claim platforms to manage caseloads efficiently. Known for empathetic communication, regulatory compliance, and commitment to accuracy in documentation and reporting. Adept at adapting to diverse claim types, jurisdictions, and carrier requirements while maintaining high customer satisfaction and cycle time performance. Claims Investigation & Resolution
Medicare & Health Insurance Sales
CMS Compliance & Regulatory Knowledge
Salesforce, CRM & Claims Software
Conflict Resolution
Remote Work Ready
Sedgwick Claims Management
State Farm Insurance
Property & Casualty Claims Adjuster
Claims Adjuster Assistant (Contract)
Processed and resolved auto and homeowners’ claims, determining liability and coordinating with policyholders, vendors, and third parties.
Conducted thorough investigations, reviewed documentation, and wrote detailed reports supporting claim decisions. Met strict deadlines for time-sensitive documentation and appeal responses. HealthPlanOne
Bachelor of Science
Adjusters License
Worker Compensation Certification
Licensed Medicare Sales Agent
Majors: Health Science
Guidewire
Microsoft Office Suite
Excel
Claims Management Software
CRM Systems
Remote Call Platforms (Five9, RingCentral)
Worker Compensation
All Line Adjusting
Xactimate
Symbility
Claim Handling
Claim Denial Review
Litagation
All lines Adjuster License in TX
Property and Casualty in GA
IRMI Worker Compensation Certified
Educated consumers on Medicare Advantage, Supplement, and Prescription Drug plans to drive compliant enrollments. Guided clients through eligibility and plan comparisons aligned with CMS standards. Delivered top-tier support to resolve inquiries, objections, and coverage concerns. Managed high call volume while maintaining strong quality assurance and compliance standards. August 2024 - March 2025
Jan 2022 - August 2024
August 2020 - Jan 2022
PROFESSIONAL SUMMARY
*************@*******.***
LinkedIn: https://www.linkedin.com/in/mychaelaprice/ Powder Springs, Ga, 30127
Mychaela Price
PROFESSIONAL EXPERIENCE
EDUCATION & CERTIFICATIONS TECHNOLOGY SKILLS
CORE COMPETENCIES
Western Governors University 2025
Life and Health Insurance License
Life and Health Producer License in GA
High School Diploma
Peachtree Ridge High School
Suwannee, Ga 2013
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