Casualty Claims Adjuster

• Apr 2022 - Present

Property & Casualty Claims Specialist

• Mar 2010 - Apr 2022

• Handled complex P & C liability, bodily injury, and damage claims in multiple states, up to company policy limits of $500,000 and $1 million umbrella coverage Limits. • Received the Highest Customer Service (CXP and NPS) scores for individual levels of service. • Received AEI Law of Insurance: General Liability Certification, AEI Homeowners: Liability Certification, and AEI Products Liability Certification. • Worked with agents, insureds, claimants, body-shops, rental companies, and third-party carriers to make proper liability decisions and provide stellar customer service to both the insured/claimant. • Maintained Compliance, Bureau of Insurance Regulations, Best Practices, and Fair Claims Act. • Utilized systems such as Phoenix, ImageRight, and CRM Systems. Show less

Account Manager & Analyst II- Insurance Department- Medical

• Nov 2009 - Mar 2010

• Worked closely with management on insurance denials and potential litigation steps. • Performed Insurance Risk Analysis, data analysis, policy review, written medical terminology application. • Maintained high-levels of customer service, while working with customers and vendors. • Explained coverages, issued denials, and advised on monetary settlements. • Worked closely with management on insurance denials and potential litigation steps. • Performed Insurance Risk Analysis, data analysis, policy review, written medical terminology application. • Maintained high-levels of customer service, while working with customers and vendors. • Explained coverages, issued denials, and advised on monetary settlements.

Medical Coding Specialist

• Aug 2008 - Nov 2008

● Provided specific information pertaining to Workers Compensation claims ● Analyzed medical information to determine medical/insurance actions.● Learned CPT Coding, ICD-9, and well-versed in medical terminology and diagnoses. ● Worked with vendors, insurance companies, customers, and medical providers regarding medical billing, treatment plans, and filing of Explanation of Benefits.

Account Manager – P&C Insurance

• Jun 2005 - Aug 2008

• Handled phone calls, greeted customers, recorded billing and handled receivables.• Managed accounts and maintained computer scheduling. • Assisted with renewals, endorsements, coverage questions, cancellations, invoicing, proposals, and negotiation with carriers. • Maintained a welcoming and upbeat demeanor and assisted Medical Coding Specialists • Valued customer and vendor opinions expanded upon team-work skills, diffused job-related issues in a professional manner. • Maintained high mutual respect levels with entirety of the company. Show less

Governmental Eligibility Worker- Client Accounts

• May 1999 - Jun 2004

• Speak and decipher qualification for governmental aid. • Compiling and analyzing governmental forms and explaining contractual agreements between state government and eligible clientele. • Worked in highly confidential information systems, maintaining quality standards of governmental documentation. • Well-versed in state and federal policies, rules, and guidelines. • Reviewed applications, conducted interviews, made eligibility determinations and maintain rapport with all parties involved. Show less