Customer Service Claim Representative

Elisha Parker

Houston, TX 832-***-**** **********@*****.***

Summary

A precise, detailed-oriented individual seeking a Claim Representative position in the insurance industry that utilizes my Indemnity Adjuster experience working within the Workers Compensation field to increase my knowledge while utilizing my customer service knowledge and skills.

Skills

●Detail Oriented

●Data Collection and Analysis

●Excellent Customer Service

●Strong problem solving aptitude

●Committed to maintaining data integrity

●Exceptional Phone Etiquette

●Excellent time management

●Team Motivator

●Effective workflow management

●Microsoft Outlook, Word and Excel proficient

Employment History

Workers' Compensation Claim Representative I – CCMSI Houston, TX

June 2017 — Present

●Investigate, evaluate and adjust medical only claims, contested medical-only claims and handle a minimum of 30 indemnity claims under direct supervision.

●Establish reserves and/or provide reserve recommendations within established authority levels under direct supervision.

●Set up designated claim files and complete all set up instructions, as requested.

●Set up independent medical exams as deemed necessary under direct supervision.

●Request and monitor medical treatment of designated claims in accordance with corporate claim standards.

●Review and approve related medical, legal, damage estimates and miscellaneous invoices on designated claims. Negotiate any disputed bills/invoices for resolution under direct supervision.

●As appropriate, make referrals to outside vendors on designated cases under direct supervision. (i.e., legal surveillance, case management, etc.)

●Effective and timely coordination of communication with clients, claimants and other appropriate parties throughout the claim adjustment process.

●Authorize and make payments on claims utilizing a claim payment program in accordance with industry standards and within established authority levels under direct supervision.

●Compute disability rates in accordance with state laws under direct supervision, when appropriate.

●Summarize all correspondence and medical records in claim log notes as well as file same in the appropriate claim.

●Review and maintain personal diary on claim system.

●Provide technical and clerical claims support to designated clients, as requested.

●Compliance with corporate claim standards and special client handling instructions as established.

Operations Supervisor - A+ Conferencing, TX Houston

March 2008 — July 2015

●Opened the office and prepared documents and schedules for the day

●Investigated and resolved customer inquiries and in an empathetic manner.

●Cross-trained and backed up other customer service managers. Assumed ownership over team productivity and managed work flow

●Facilitated inter-departmental communication to effectively provide customer support.

●Trained staff on operating procedures and company services.

●Oversaw call center employees to ensure customer satisfaction goals were consistently

●Met or exceeded service and quality standards every review period.

Customer Service Representative - Xerox Corp. at Sprint/Nextel, Houston, TX

February 2006 — February 2000

●Business to Business sales of Sprint/Nextel equipment and Services

●Resolved service and price inquiries for customers by asking clear and specific questions.

●Managed high call volume with tact and professionalism.

●Resolved technical support issues.

Licenses: Texas Department of Insurance

License:# 2256768 Adjuster ( Adjuster - All Lines )

Begin Date: 07-01-2024 Review Date: 06-30-2026

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