Insurance Claims & Customer Service Professional

JENNIFER LONG

**********@*****.***• 216-***-****

**** *. **** ******, ******** Heights, OH, 44125

CAREER

SUMMARY: Self-motivated professional with relevant years of education and work experience. Organized and detail-oriented individual who exemplifies professionalism, and the ability to manage multiple projects and tasks at any given moment. Experienced insurance agent with the desire for increased responsibility and professional growth.

EDUCATION: Tiffin University August 2009 – May 2010

Concentration: Criminal Justice Tiffin, OH

University of Phoenix August 2011 – May 2016

Concentration: Business

Cleveland, OH

SKILLS:

Critical Thinking Logical Reasoning Enthusiastic and experienced in dealing with the general public Proficient in Microsoft Office applications Type 50 WPM Ability to effectively manage time and perform duties without close supervision. Public Speaking Strong attention to detail Strong business acumen, including problem solving, collaboration, leadership, and the ability to analyze diverse facts.

WORK EXPERIENCE:

AAA, Independence, Ohio

ERS/Dispatch, January 2021- Present

●Handles 80+ customer calls a day, providing personalized and friendly service to ensure customer retention.

●Uses creative problem-solving to respond to customer request and complaints with company procedures.

●Assist with other departments, including insurance claims, first notice of loss, membership sales and dispatch calls.

●Engaging with customers and providing product information to drive sales.

●Processing payments, fast-paced environment, multitasking

● Followed detailed company procedures, maintaining metrics for all different departments worked.

Sedgwick, Independence, Ohio

Auto Claims Representative, September 2018 – January 2021

●Investigated claims and obtained relevant facts to determine coverage, loss, and liability.

●Interacted effectively with customers, insurance agents, police, attorneys, and other public personnel involved in the claims process.

●Documented claim file activities in an accurate and timely manner.

●Performed negotiations with insured and claimant to achieve claim settlements.

●Analyzed and processed simple and complex claims in accordance with company policy.

●Worked closely with outside companies, receiving and sending appropriate documentations, in addition to performing background searches and obtaining police reports.

●Processed payments and set up payment plans pursuant to company guidelines and state requirements.

Cardinal Health, Twinsburg, Ohio

Medical Insurance Verification Specialist, February 2016 – August 2018

●Initiated authorization requests with insurance companies and government payers and obtains the necessary documentation.

●Monitored outstanding authorization requests and initiates follow up of outstanding authorizations in a timely manner.

●Initiated contact with insurance companies to obtain current authorization requirements.

●Monitored the accuracy and timeliness of order processing, qualification of revenue, confirmation of delivery tickets, and customer demographic and insurance information.

●Verified Medicare, Medicaid, and commercial insurances.

●Completed daily follow-up process on all assigned patients/equipment to ensure prompt payment.

●Responsible for provider reimbursement programs, policies and strategies to ensure unit cost controls meet or exceed agency objectives for medical cost containment.

●Responsible for revenue cycle reporting, providing transparency of cycle times to ensure early identification of issues and resolution.

●Continually monitor metrics in order to refine processes and improve efficiencies.

●Ensured agency remains current with all federal, state and local regulations.

Allstate, Hudson, Ohio

Property/Auto Adjuster, March 2015 – October 2016

●Interviewed, telephoned and corresponded with claimant and witness; consults policies; inspects property damage to determine extent of client's liability and determine.

●Identified subrogation issues and prepared subrogation notifications as directed by client.

●Obtained reports from experts as requested and secured reports on incidents or accidents investigated by local, regional and national authorities.

●Evaluated and investigated policy coverage, liability and damages in a timely manner following a set of general claim and statutory guidelines.

●Negotiated timely and appropriate settlements with claimants, insureds and attorneys, issue proper payments.

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