Columbia, MD. 2017- Current
Carday Associates, Inc. provides administrative and consulting services to a variety of Benefit Funds. Carday Associates, Inc. clients include many Taft-Hartley Multi-employer Benefit Funds, multiple employer Funds and local unions. Carday Associates, Inc have served the benefits community with pride since 1952.
Serves medical insurance patrons by determining insurance coverage; examine and resolve medical claims; document actions; maintain quality customer services; ensure legal compliance.
•Determines covered medical procedures by reviewing requirements of insurance policy.
•Establish proof of medical services by studying medical documentation; collecting additional information as required from outside sources, including claimant, physician, employer, hospital, and other insurance companies; initiating or conducting investigation of questionable claims.
•Resolves medical claims by approving or denying documentation; calculating benefit due; initiating payment or composing denial letter.
•Maintains quality customer services by following customer service practices; responding. Subrogation Administrator
• Responsible for subrogation activities including the identification and research of subrogation claims. Assists in the recovery of overpayments for duplicate coverage, workers' compensation, and no-fault claims. Identifies legal liability and pursues, negotiates, and settles subrogation collection.
• Researches paid claims, answers inquiries, and coordinates with other departments, insurance adjustors, attorneys, and members. Interacts with policyholders, claimants, witnesses, and underwriters to recommend and document the necessary information to close a file.
- Claim Examiner at Carday Associates Inc
- DME Collection Specialist at Johns Hopkins Medicine
- Reimbursement Specialist at Maxim Healthcare Service
- Error Processing Supervisor at AMERITOX
2 years at this Job
- Master Certificate - Medical Terminology
- BS - Health Services Management
● Verify cause of loss is covered in insurance contract
● Review field adjuster estimate, inspection report, photos and prior losses
● Revise or request revisions to Xactimate estimate as necessary
● Explain verbally and in writing any damage that is being denied
● Ensure all items needed to complete the claim are documented in the file and reviewed with Insured
● Quality Customer Service
● Handling both CAT claims and daily claims ◦ 10/10/2018-11/10/2018 - Team Lead assignment for team of 8 adjusters ◦ Trained inside adjusters set forth by the carrier focusing on accuracy based on the policy and customer service ◦ Review and correcting of Coverage decision letters, Appraisal Demand letters, Proof of loss rejection letters ◦ Reviewed and Approved estimates submitted by Desk Adjusters for claim authority
- Claim Examiner at Ryze Claim Solutions
- Quality Customer Service at National Lloyd's Insurance
- Catastrophe Adjuster at
- Claims Specialist at State Farm
11 months at this Job
- License - General Studies
- - General Studies
• Review, research and investigate Group Life claim Submission.
• Develop detailed letter of explanation based on policy provisions.
• Interpret policy provisions and manually adjudicate Group Life Claims.
• Initiate investigation to obtain autopsy, toxicology, accident and police reports.
• Introduced new ideas to improve work process.
• Organized time and priorities to achieve business results
• Offer guidance and support to less experienced examiner.
- Claim Examiner at MET-LIFE
- at Bank of America
- at ACS Education Services
- at Ten Ten Entertainment
10 years, 3 months at this Job
- Bachelor of Science - Electrical Engineering Technology
- Associate in Applied Science - Electronics Engineering
• Applied knowledge of commercial auto policies and endorsements as well as state laws and regulations to investigate, negotiate, and settle claims nationwide
• Ensured that claim handling was compliant to
• Handled a high volume of claims utilizing both virtual and centralized system environments.
• Ensured integrity of investigations was in line with clients' expectations and were completed in a timely and professional manner.
• Issued payments as per discretionary settlement authority limits.
• Adhered to clients' procedures to investigate claims, evaluate written or computerized auto estimates, initiate claim payment, arrange rental vehicle services, process and close files
- COMMERCIAL AUTO CLAIM EXAMINER at 2B Claim Services
- PERSONAL AUTO CLAIM TEAM SUPERVISOR at 2B Claim Services
- TOTAL LOSS CLAIMS ASSOCIATE at State Farm Insurance
- PROPERTY CLAIM ASSOCIATE at State Farm Insurance
9 months at this Job
- Associate - Culinary Arts
- Associate - General Business
Sedgwick Claims Management Claim adjuster for high exposure, complex and technically difficult general liability, auto liability, product defect and construction defect. Claims handled involved litigation and rehabilitation. Ensuring that ongoing adjudication of claims within service expectations. Practiced industry best standards and specific client service requirements. Ensured proper identification of subrogation and tender potential. Establish range and negotiate settlements. High volume of case management involving consistent communication with insured members, claimants, plaintiff and defense counsel, expert panels and internal partners. Mentor and train new coworkers in process and procedures related to claim processing and communications.
- Claim Examiner at Liability
- Claim Adjuster at Travelers Property Casualty Corp
- Eligibility Technician II at Yuba County Health and Human Services
- Assistant Retail Sales Operations at Verizon Wireless
10 months at this Job
- Bachelor's - Psychology
• Determines eligibility under federal and state requirements for leaves submitted and determines eligibility under client's plan/policy.
• Responds to customer service issues within required timeframes.
• Pro-actively communicates decisions within Best Practice guidelines, consistently meeting Performance Guarantee requirements.
• Makes determinations to approve, deny or delay and or reach out to additional.
• resources for review, based on medical certification review and management.
• Determines the duration associated with the leave and or disability based on the information given by the healthcare provider.
• Communicates approvals, denials, leave extensions, return to work plans and other important information regarding the leave to the employee and client.
• Manages leaves that are concurrent with Short Term Disability and Workers' Compensation.
• Manages intermittent, continuous and client specific leaves of absences.
• Handle calls and e-mails daily, discussing claim status, policy provisions and state/federal regulations
• Receiving inbound and outbound calls pertaining to leaves, answer general questions regarding claims
• Document information into the database, and complete tasks in a timely manner.
• Responding and receiving faxes and emails regarding pay, time off, documents, comments, questions or concerns as well as solutions.
• Navigate multiple systems and multi task.
• Keep a log of work completed and notate claims with detail.
• Have strong phone etiquette.
- Claim Examiner at Matrix Absence Management
- Customer Service Representative/Data Entry at Yandy.com
- Data Entry/ Customer Service/ Traffic Control at Summit Warehouse
- Medical Records Group Agent at Ciox Health
6 months at this Job
- High school
• Consulted as a 3rd party administrator for corporate clients by highlighting potential claim exposures.
• Investigated and negotiated liability claims including evaluation of medical records and causation for injury.
• Determined liability through obtaining recorded statements and communicating with outside vendors as part of each liability investigation. Analyzed and evaluated attorney demands to negotiate a prompt and fair settlement.
- Claim Examiner at Crawford & Company
- Bodily Injury Claims Adjuster at Liberty Mutual
- Claims Associate at State Farm
- Customer Care/ Sales Representative at State Farm
2 months at this Job
- Bachelor of Arts - Sociology
Review medical claims Make sure member has effective health insurance on the date of service Make sure all information is present or correct Follow procedures to pay, deny, or ask for more information on a claim Process 120-180 claims a day
- Claim Examiner at Healthfirst
- Visa and Passport Specialist I at CIBT Visas, Inc.
- Customer Service Representative at Xerox (COX Communications)
- Customer Service Rep (AT&T) at Advanced Call Center Technology
1 year, 1 month at this Job
- AA - Business Entrepreneurship
Prompt and thorough investigation of claims within departmental and regulatory guidelines. ◦ Interprets and administers contract provisions ◦ Develops, implements and modifies disability management plan to establish strategy and manage outcome. ◦ Documents claim file actions and telephone conversations appropriately. ◦ Refers claim activity outside authority level to Supervisor/Manager for review. ◦ Pro-actively communicates with claimants, policyholders, and physicians to resolve investigations issues. ◦ Establishes, communicates and manages claimant and policyholder expectations. ◦ Utilizes most efficient means to obtain claim information. ◦ Fully investigates all relevant claim issues, provides payment or denials promptly and in full compliance with departmental procedures and Unfair Claims Practice regulations. ◦ Responds to customer service issues within required timeframes. ◦ Refers claims above authority to a supervisor/manager. ◦ Demonstrates ability to independently handle claims not of a complex nature. ◦ Involves technical resources at appropriate claim junctures. ◦ Supports relationships with technical resources to achieve appropriate outcomes. ◦ Meets or exceeds departmental service, quality and production objectives. ◦ Collaborates with team members and management in identifying and implementing improvement opportunities.
- LTD Claim Examiner I at Reliance Standard Life Insurance
- Assistant to the President at
- Clerk at McMenamin Family Shoprite
- Intern at Pennypack Beverage
2 years, 1 month at this Job
- B.S. - Business Marketing & Management Option
Assist insures with claims from Hail, ice dams, wind, fire, tornado and Hurricane. Handling the claims Customer service, processing payments and submitting supplement and processing supplements. Including IPLS inside adjusting. Reviewing policy and setting up reserves
- Claim Examiner at
- Construction manager at AA Stucco & Painting
2 years, 1 month at this Job
- Bachelor's - Business Management