Team Leader Call Center
Resume:
Karly B Furtaw
Grandview, MO ***30
***********@*****.***
Professional Summary & Skills
Insurance Claims professional with over 5 years of experience handling Auto, Workers Compensation, Errors & Omissions and Property & Casualty Claims. 8 years of Call Center experience, including high-volume. Proficient in Microsoft Office Word, Excel, and Outlook. Education:
Graduated Belton High School (Belton, MO 1994-Diploma) Johnson County Community College (1994) General Studies-College Prep University of Missouri-Columbia (1994-1997) Business Administration & Accounting Professional Experience:
Auto General Liability Claims Examiner
Experis Temp Services/US-division of Manpower Group (06/2023-10/2023) Chubb (ESIS)
Receives assignments and reviews claim and policy information to provide background for investigation and may determine the extent of the policy’s obligation to the insured depending on the line of business.
- Contacts, interviews and obtains statements (recorded or in person) from insureds, claimants, witnesses, physicians, attorneys, police officers, etc. to secure necessary claim information.
- Depending on line of business may inspect and appraise damage for property losses or arranges for such appraisal.
- Evaluates facts supplied by investigation to determine extent of liability of the insured, if any, and extend of the company’s obligation to the insured under the policy contract.
- Prepares reports on investigation, settlements, denials of claims, individual evaluation of involved parties.
-Entered all settlement amounts into spreadsheet each day per procedure to report accounts payable.
- Sets reserves within authority limits and recommends reserve changes to Team Leader.
- Reviews progress and status of claims with Team Leader and discusses problems and suggested remedial actions.
- Prepares and submits to Team Leader unusual or possible undesirable exposures.
- Assists Team Leader in developing methods and improvements for handling claims.
- Settles claims promptly and equitably.
- Obtains releases, proofs of loss or compensation agreements and issues company drafts in payments for claims.
- Informs claimants, insureds/customers or attorney of denial of claim when applicable. Claims Associate II 09/2021-06/2023
UST Global, Inc
Responsible for processing assigned claims based on client-specified guidelines. Attend meetings regarding any Client guideline updates and any processing trends. Responsible for meeting complex claims productivity targets of claims per hour or day as set by supervisor. Mentor junior members of the team. Collaborate with other team members on special projects such as audits of accounts using spreadsheets to compare values of claims against a main shared spreadsheet of dollar amounts going out, and manage any process documentation. Reconcile denied claims by contacting Insurance Companies and going over denials per the Explanation of Benefits to come to resolution. Knowledge of Coordination of Benefits. Knowledge of physician practice and hospital coding, billing and medical terminology including CPT, HCPCS, and ICD-10, UB04 form and CMS 1500 form. Ability to process in upwards of 60 claims per day to their completion.
Billing Specialist 01/2021-05/2021
Tueller Counseling (Idaho Falls, ID)
Responsible for keeping track of money owed to the company by clients and insurance companies, prepare invoices for our community. Insurance verification for our patients. Handle accounts and payments via a shared spreadsheet for the department, entering the values of each claim being handled. Manage all documents with efficiency. Contributed to the accurate preparation of bills receivable and safeguard the company's income. Conducted weekly audits of the payments of patient accounts by entering data in Excel and comparing against a main, shared spreadsheet.
Medical Records Specialist 11/11/2020-01/2021
Eden Home Health & Hospice (Idaho Falls, ID)
Supply nursing and physical therapy staff with required forms and documents, verification of insurance for our patients, maintain data collection and skills acquisition files, protect medical records from loss or defacement prior to the end of retention periods, schedule patients for nursing or physical therapy visits, maintain current face sheet for every patient admitted, process admission and discharge records accurately and in a timely manner, maintain strict confidentiality of all medical records and PHI.
Home Mortgage Loan Quality Analyst 03/11/2020-06/04/2020 Modis Temp Services (Overland Park, KS)
Prepares and processes mortgage loan records, files and correspondence from application through approval. Assures compliance with bank, regulatory and investor guidelines and customer service standards. Communicates with customers, internal staff, brokers, counsel, title companies, etc. to respond to inquiries, resolve problems and obtain all necessary documentation required for the file.
Claims Adjuster/Analyst 10/2018 –05/2019
Western General (Calabasas, CA)
Investigate, analyze, and determine the extent of insurance company's liability concerning personal, casualty, or property loss or damages, and attempt to effect settlement with claimants. Correspond with or interview medical specialists, agents, witnesses, or claimants to compile information. Analyze information gathered by investigation and report findings and recommendations. Collect evidence to support contested claims in court. Analyzes and reviews insurance claims for accuracy, completeness, and eligibility. Maintains updated records and prepares required documentation. Assisted in controlling the cost of processing claims. Contacts policyholders about claims and may provide information regarding the amount of benefits. Insurance Claims Examiner 09/2017 – 07/2018
Tripmate Inc. (Kansas City, MO)
Settled claims with claimants in accordance with policy provisions Compared data on claim applications, physician statements, or death certificates with policy file and company records to ascertain completeness and validity of claims. Performed resolution of claims by communicating or interacting with travel providers, claimants or others involved in the claim to resolve coverage questions. Examined reports to determine coverage. Paid claimants’ amounts due according to settlement agreements. Reviewed and resolved disputed claims in accordance with the claimant’s policy provisions.
Deli Associate 07/2017 – 11/2017
Price Chopper (Louisburg, KS)
Providing face-to-face Customer Service by assisting customers in purchasing any food items they request from the deli. Providing made-to-order meals, deli meats and/or cheeses for customers. Cleaning deli during a closing shift.
Claims Support Technician 08/2013 – 08/2016
AIG (Olathe, KS)
New York Workers Compensation Board Specialist - process and ensure payments and/or penalties are paid by Adjusters in a timely manner according to procedure and compliance per Court Orders. Updated Hearing and Pre-Hearing dates to ensure AIG Attorneys are present for Court dates. Researched any penalties and find a solution for prevention of reoccurrence. Review Notice of Decisions by NY State, Orders of the Chair, etc to ensure timely and accurate payment. Processed Adjuster requests for Print & Mail Communication. Financial Lines Claim Setup Technician · Analyzing coverage for our Insured in the areas of Specialty Claims, Property & Casualty, Errors and Omissions. Investigating facts and evaluating liability and damages. Reserving and resolving claims. Communicate with insureds and brokers and negotiate claim resolution. Establishing claims for our Insured within the realm of the Financial Lines Department. Drafting and sending correspondence to brokers and our Insured Participant Care Representative 2/2012 – 8/2013
Acclaris, Inc (Kansas City, MO)
Fielding incoming calls for Participant Reimbursement Healthcare Programs. Maintaining current knowledge of, and not limited to plans such as: HCRA, ERP, DCRA, HAS, HRA. Making Supervisor callbacks for participants wishing to escalate any issue they have deemed unsatisfactory. Validation and verification of accounts for clients · Up-to-date with HIPAA regulations. Mentoring incoming and current associates in Reimbursement Program provisions. Pharmacy Benefit Analyst 09/2001– 11/2011
(2 separate dates of employment) *
Argus Health Systems/DST Systems, Inc. (Kansas City, MO) Analysis for existing business processes and procedures to ensure Customers requests are Fulfilled. Coding programs to ensure patients/Customer s claims are processed with a positive outcome. Processing claims for Commercial, Medicaid and Medicare Part D Insurance. Ensuring a high level of quality in the Quality Focus Group-minimize error; maximize quality. Monitor Customer formularies as instructed. Operating according to HIPAA rules and regulations · Call Center experience: Determine billing issues for Commercial Claim issues, Communication with pharmacy reps, doctors, TPA s
regarding Coordination of Benefits, Medicare Part B & D. Accolades:
Junior Ambassador to China and Japan; 2 years on University of Missouri’s Dean’s List
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