Experience

Clearcover

• United States
• Insurance
• 200 - 300 Employee

• PIP Claims Representative IV

  • Aug 2023 - Present

  Chicago, Illinois, United States -Review assigned claims in the following states: Alabama, Arizona, California, Georgia, Illinois, Indiana, Kentucky, Louisiana, Maryland, Mississippi, Missouri, Nebraska, Ohio, Oklahoma,Pennsylvania, Texas, Utah, Virginia, West Virginia, Wisconsin -Contact the insured and other affected parties, set expectations for the remained of the claim, and initiate documentation in the claim handling system. -Complete coverage analysis including a review of policy coverages and provisions, and the… Show more -Review assigned claims in the following states: Alabama, Arizona, California, Georgia, Illinois, Indiana, Kentucky, Louisiana, Maryland, Mississippi, Missouri, Nebraska, Ohio, Oklahoma,Pennsylvania, Texas, Utah, Virginia, West Virginia, Wisconsin -Contact the insured and other affected parties, set expectations for the remained of the claim, and initiate documentation in the claim handling system. -Complete coverage analysis including a review of policy coverages and provisions, and the applicability to the reported loss. -Ensure all possible policyholder benefits are identified, create additional sub-claims if needed or refer complex claims to management or the appropriate claim handler. -Complete an investigation of the facts regarding the claim to further and in more detail determine if the claim should be paid, the applicable limits or exclusions and possible recover potential. -Conduct thorough reviews of damages and determine the applicability of state law and other factors related to the claim. -Evaluate the financial value of loss. -Approve payments for the appropriate parties accordingly. -Refer claims to other company units when necessary (e.g., Underwriting, Recovery Units or Claims Special Investigation Unit). -Thoroughly document and/or code the claim file and complete all claim closure and related activities in the assigned claims management system. -Utilize strong negotiating skills. -Handle litigated claims and work with defense counsel on resolution.

• PIP Claims Representative III

  • Sep 2022 - Sep 2023

  Chicago, Illinois, United States -Review assigned claims in the following states: Alabama, Arizona, California, Georgia, Illinois, Indiana, Kentucky, Louisiana, Maryland, Mississippi, Missouri, Nebraska, Ohio, Oklahoma,Pennsylvania, Texas, Utah, Virginia, West Virginia, Wisconsin -Contact the insured and other affected parties, set expectations for the remained of the claim, and initiate documentation in the claim handling system. -Complete coverage analysis including a review of policy coverages and provisions, and the… Show more -Review assigned claims in the following states: Alabama, Arizona, California, Georgia, Illinois, Indiana, Kentucky, Louisiana, Maryland, Mississippi, Missouri, Nebraska, Ohio, Oklahoma,Pennsylvania, Texas, Utah, Virginia, West Virginia, Wisconsin -Contact the insured and other affected parties, set expectations for the remained of the claim, and initiate documentation in the claim handling system. -Complete coverage analysis including a review of policy coverages and provisions, and the applicability to the reported loss. -Ensure all possible policyholder benefits are identified, create additional sub-claims if needed or refer complex claims to management or the appropriate claim handler. -Complete an investigation of the facts regarding the claim to further and in more detail determine if the claim should be paid, the applicable limits or exclusions and possible recover potential. -Conduct thorough reviews of damages and determine the applicability of state law and other factors related to the claim. -Evaluate the financial value of loss. -Approve payments for the appropriate parties accordingly. -Refer claims to other company units when necessary (e.g., Underwriting, Recovery Units or Claims Special Investigation Unit). -Thoroughly document and/or code the claim file and complete all claim closure and related activities in the assigned claims management system. -Utilize strong negotiating skills.



Progressive Insurance

• United States
• Insurance
• 700 & Above Employee

• Florida PIP Litigation Representative

  • Aug 2021 - Sep 2022

  St Petersburg, Florida -Construct supportive written documentation to successfully bring about a resolution to the file. -Developed and document the strategy for dispute resolution. -Consults and/or negotiates with internal or external legal counsel. -Attend legal proceedings including depositions, hearings and/or trials. -Processes arbitration decisions -Review arbitration requests and lawsuits to determine actions warranted (defense or settlement). -Seeks to resolve disputes on unpaid medical… Show more -Construct supportive written documentation to successfully bring about a resolution to the file. -Developed and document the strategy for dispute resolution. -Consults and/or negotiates with internal or external legal counsel. -Attend legal proceedings including depositions, hearings and/or trials. -Processes arbitration decisions -Review arbitration requests and lawsuits to determine actions warranted (defense or settlement). -Seeks to resolve disputes on unpaid medical bills via settlement or defense based on file review findings. -Document and forwarding of hearing notices. -Responds to or reviews correspondence including defense bills and settlement terms. -Occasional travel

• New York PIP Litigation Representative

  • Feb 2020 - Aug 2021

  Albany, New York Area -Construct supportive written documentation to successfully bring about a resolution to the file. -Developed and document the strategy for dispute resolution. -Consults and/or negotiates with internal or external legal counsel. -Attend legal proceedings including depositions, hearings and/or trials. -Processes arbitration decisions -Review arbitration requests and lawsuits to determine actions warranted (defense or settlement). -Seeks to resolve disputes on unpaid medical… Show more -Construct supportive written documentation to successfully bring about a resolution to the file. -Developed and document the strategy for dispute resolution. -Consults and/or negotiates with internal or external legal counsel. -Attend legal proceedings including depositions, hearings and/or trials. -Processes arbitration decisions -Review arbitration requests and lawsuits to determine actions warranted (defense or settlement). -Seeks to resolve disputes on unpaid medical bills via settlement or defense based on file review findings. -Document and forwarding of hearing notices. -Responds to or reviews correspondence including defense bills and settlement terms. -Occasional travel

• Medical Claims Representative Intermediate

  • Jan 2019 - Feb 2020

  Albany, New York Area * Focus on Out of State & Commercial Claims * Interviews, collects and documents information from customers, agents, witnesses, police reports, etc. * Interprets policies and analyzes information gathered to determine course of action. * Ensures that all damage is consistent with the report of the accident. * Negotiates with customers and claimant carriers when claims cannot be settled in full. * Recognizing applicable exposures and endorsements. * Referring questionable… Show more * Focus on Out of State & Commercial Claims * Interviews, collects and documents information from customers, agents, witnesses, police reports, etc. * Interprets policies and analyzes information gathered to determine course of action. * Ensures that all damage is consistent with the report of the accident. * Negotiates with customers and claimant carriers when claims cannot be settled in full. * Recognizing applicable exposures and endorsements. * Referring questionable claims for further investigation. * Resolving total losses to include execution of total loss paperwork. * Referring claims for subrogation opportunities. * Managing claims inventory workload which includes paperwork associated to claim, diaries, mail, phones, and issues payments as needed.

• Medical Claims Representative

  • Feb 2018 - Jan 2019

  Albany, New York Area Reviews and researches policy contract, regulation and cause of injury to make coverage decisions • Recognizes the potential exposure of a claim and adjust reserves accordingly • Identifies, reviews and researches wage loss expenses and documentation for payment consideration • Reviews and interprets policy language when subrogation demand is received to determine if reimbursement is owed • Interprets medical records and understands medical terminology regarding injuries •… Show more Reviews and researches policy contract, regulation and cause of injury to make coverage decisions • Recognizes the potential exposure of a claim and adjust reserves accordingly • Identifies, reviews and researches wage loss expenses and documentation for payment consideration • Reviews and interprets policy language when subrogation demand is received to determine if reimbursement is owed • Interprets medical records and understands medical terminology regarding injuries • Conducts research to understand correlations between medical records and motor vehicle accidents, injuries or medical conditions

• Claims Generalist Associate

  • Feb 2017 - Feb 2018

  Albany, New York Area * Interviews, collects and documents information from customers, agents, witnesses, police reports, etc. * Interprets policies and analyzes information gathered to determine course of action. * Ensures that all damage is consistent with the report of the accident. * Negotiates with customers and claimant carriers when claims cannot be settled in full. * Recognizing applicable exposures and endorsements. * Referring questionable claims for further investigation. * Resolving… Show more * Interviews, collects and documents information from customers, agents, witnesses, police reports, etc. * Interprets policies and analyzes information gathered to determine course of action. * Ensures that all damage is consistent with the report of the accident. * Negotiates with customers and claimant carriers when claims cannot be settled in full. * Recognizing applicable exposures and endorsements. * Referring questionable claims for further investigation. * Resolving total losses to include execution of total loss paperwork. * Referring claims for subrogation opportunities. * Managing claims inventory workload which includes paperwork associated to claim, diaries, mail, phones, and issues payments as needed.



Apple

• United States
• Computers and Electronics Manufacturing
• 700 & Above Employee

• Genius Admin

  • Oct 2015 - Feb 2017

  Albany, New York Area • Share information and provide service that continuously enhances the customer experience. • Manages and oversees all operational activities in the Genius Room. • Manages the “quick repair process”: identifies, prioritizes, and stages all quick repairs that are completed while the customer waits. • Keeps customers updated on repair status to minimize potential negative impact of aging repairs. • Manages customer pickup process for all completed repairs, including… Show more • Share information and provide service that continuously enhances the customer experience. • Manages and oversees all operational activities in the Genius Room. • Manages the “quick repair process”: identifies, prioritizes, and stages all quick repairs that are completed while the customer waits. • Keeps customers updated on repair status to minimize potential negative impact of aging repairs. • Manages customer pickup process for all completed repairs, including identifying, verifying, and preparing. • Works with Inventory Control to manage and track service repair inventory; is acutely aware of inventory levels and orders replacement consumables. • Assists with customer service issues. • Stays alert to loss-prevention issues; uses checks and balances based on processes and reports. • Processes received depot repairs: verifies successful repair, confirms repairs, contacts customers, and manages case notes. • Manage end-of-month and new-month paperwork, CRU paperwork, and document storage.

• Technical Specialist

  • Nov 2014 - Oct 2015

  Albany, New York Area • Provide insightful advice and friendly, hands-on technical support to Apple customers in need. • Diagnose product issues on the spot, explaining situations with patience and empathy. • Determining whether repairs can be done or a replacement is needed and offer solutions to quickly get users up and running again. • Fulfill Apple's service commitment with style, speed, and skill all while earning the trust of customers and coworkers alike as I offer guidance, knowledge, and even… Show more • Provide insightful advice and friendly, hands-on technical support to Apple customers in need. • Diagnose product issues on the spot, explaining situations with patience and empathy. • Determining whether repairs can be done or a replacement is needed and offer solutions to quickly get users up and running again. • Fulfill Apple's service commitment with style, speed, and skill all while earning the trust of customers and coworkers alike as I offer guidance, knowledge, and even tips and training.

• Specialist

  • Aug 2014 - Nov 2014

  Albany, New York • Help in creating energy and excitement around Apple products, providing solutions and getting products into customers' hands. • Staying on top of news about products and initiatives. • Constant learning of Apple products and software to better demonstrate to customers and answer their questions.



Princess House

• Manufacturing
• 300 - 400 Employee

• Independent Consultant

  • Apr 2014 - Apr 2015

  Rotterdam, NY • Selling & demonstrating cookware, bake ware, utensils and various household items to consumers. • Scheduling dates & times with current and potential host(ess). • Setting up displays prior to selected time of demonstration. • Inputting orders and collecting payment for host(ess). • Product purchasing to stay up-to-date with latest offerings. • Attending monthly unit/area meetings. • Travel as needed.



Ellis Medicine

• United States
• Hospitals and Health Care
• 700 & Above Employee

• Training Assistant

  • Mar 2012 - Dec 2014

  Schenectady, NY •Training & developing curriculum for new and current employees. Systems include Soarian Financials, PRM and AllScripts along with health insurance training. Creating & designing courseware and educational materials for systems listed. •Scheduling training rooms for classes and meetings. •Go-live support and assisting practices with back loading of appointments, demographics and insurance information, as well as verifying insurance coverage. Travel to other practices as… Show more •Training & developing curriculum for new and current employees. Systems include Soarian Financials, PRM and AllScripts along with health insurance training. Creating & designing courseware and educational materials for systems listed. •Scheduling training rooms for classes and meetings. •Go-live support and assisting practices with back loading of appointments, demographics and insurance information, as well as verifying insurance coverage. Travel to other practices as needed. •Coaching “super” users, making them strong system users for other employees in their practice. •Help desk support for Soarian Financials and AllScripts. Logging and tracking end user issues via magic ticket system. •Assisting Manager of Physician Practices as needed. •Scheduling and attending meetings as needed.

• Clerical Coordinator/Medical Assistant

  • Jul 2007 - Mar 2012

  Schenectady, NY •Answering phones, taking messages for appropriate doctor/nurses, and triaging phones calls for emergencies; filing, copying and various office work •Secretary to three doctors/2 nurse practitioners (Primary Care, Wound Care & Neurology) – scheduling patient appointments, radiological procedures, surgery and various other tests/procedures and confirming patients appointments •Check In and Out – Making sure patients insurance and demographic information is correct at the time of… Show more •Answering phones, taking messages for appropriate doctor/nurses, and triaging phones calls for emergencies; filing, copying and various office work •Secretary to three doctors/2 nurse practitioners (Primary Care, Wound Care & Neurology) – scheduling patient appointments, radiological procedures, surgery and various other tests/procedures and confirming patients appointments •Check In and Out – Making sure patients insurance and demographic information is correct at the time of appointment; verifying insurance coverage via the internet & HDX, collecting co-pays and putting together the deposits •Obtaining prior authorizations from insurance companies for radiological procedures, admissions and various testing •Referrals for the appropriate insurance company for patients that see specialists. •Troubleshooting various computer/copy machine problems, ordering office supplies •Creating electronic office forms and testing scripts. •Obtaining patients vital signs (blood pressure, temperature, height, weight, BMI.) •Interviewing/getting patients ready for the nurse practitioner and doctors. •Writing up renewal prescriptions for the patients. •Point of Care testing (urine, pregnancy, strep throat testing, HIV) obtaining and prepping specimens to send to the lab. •Stocking rooms with appropriate medical equipment and supplies needed for procedures and surgeries. •Project leader for transition to electronic medical records & teaching staff.



CapitalCare Medical Group

• Administrative Assistant

  • Jun 2004 - Jul 2007

  Schenectady, NY •Answering phones, taking messages for appropriate doctor/nurses, and triaging phones calls for emergencies; filing, copying and various office work •ICD-9 Coding •Secretary to four doctors/1 nurse practitioner – scheduling patient appointments, radiological procedures, surgery and various other tests/procedures and confirming patients’ appointments, calling in prescriptions and obtaining prior authorization if needed. •Check In and Out – Making sure patients insurance and demographic… Show more •Answering phones, taking messages for appropriate doctor/nurses, and triaging phones calls for emergencies; filing, copying and various office work •ICD-9 Coding •Secretary to four doctors/1 nurse practitioner – scheduling patient appointments, radiological procedures, surgery and various other tests/procedures and confirming patients’ appointments, calling in prescriptions and obtaining prior authorization if needed. •Check In and Out – Making sure patients insurance and demographic information is correct at the time of appointment; verifying insurance coverage via the internet, collecting co-pays and putting together the deposits •Obtaining prior authorizations from insurance companies for radiological procedures, admissions and various other testing •Referrals for the appropriate insurance company for patients that see specialists. •Troubleshooting various computer/copy machine problems •Addressing and correcting patient billing issues via the phone & e-mail •Creating office forms and testing scripts •Project leader for transitioning office to electronic medical records. Show less



Albany Medical Center

• Office Manager

  • Jan 2001 - Jan 2004

  Albany, NY •Answering phones, taking messages for appropriate doctor/nurses, and triaging calls for emergencies; filing, copying and various office work •Inpatient billing/ICD-9 & CPT coding •Making daily deposits from co-pays and making sure billing had all billing sheets for patients that were seen •Secretary to five doctors – scheduling patient appointments, radiological procedures, surgery and various other tests •Obtaining prior authorizations from insurance companies for radiological… Show more •Answering phones, taking messages for appropriate doctor/nurses, and triaging calls for emergencies; filing, copying and various office work •Inpatient billing/ICD-9 & CPT coding •Making daily deposits from co-pays and making sure billing had all billing sheets for patients that were seen •Secretary to five doctors – scheduling patient appointments, radiological procedures, surgery and various other tests •Obtaining prior authorizations from insurance companies for radiological procedures, admissions and various other tests •Troubleshooting computer/copy machine problems •Ordering of office supplies and various teaching books for the department •Keeping track of the doctors professional spending account •Credentialing papers for the doctors/ making sure all licenses & appropriate tests were up to date •Preparing consents for the IRB to review before patients go on study •Supervising 3 person clerical staff Show less