Long Term Disability claim examiner
Long Term Disability claim examiner
- Senior Claim Examiner at Lincoln Financial Group
- Senior Claim Examiner- Long Term Disability at Lincoln Financial Group
4 years, 6 months at this Job
- Metropolitan Community College - LPN-C
- LPN-C - Nursing
- Some college
• Catastrophe Team Member for Hurricane Maria.
• Responsible for reviewing claims to ensure that proper guidelines and processes are followed.
• Consult with experts in different fields and study medical records.
• Coordinate meeting with attorneys to discuss cases assigned to them.
• Evaluate damages to ascertain compensation amount.
• Provide settlement authorization. INTEGRAND ASSURANCE COMPANY (2014 at present) San Juan, PR Legal Claim Examiner
- Legal Claim Examiner at INTEGRAND ASSURANCE COMPANY
- Auto and Liability Claim Supervisor at
- Legal Examiner and Medical Malpractice Claims Analyst at AMERICAN INTERNATIONAL INSURANCE COMPANY
5 years, 8 months at this Job
- Arts - Minor - Criminal Justice
Ensure proper Guidelines were followed during claim phases, review costs were reasonable, evaluate all information to determine how claim should be handled, negotiate with claimant settle claim, issue payout amounts, prepare and present claims to insurance companies.
- Claim Examiner at BRMS
- Claim Examiner at Capitola Administrators
- LPS Loan Processor Service - Loan Officer at Mcclellan
- Customer service at Red Hawk Casino
4 years, 1 month at this Job
- - Accounting
- High School Certificate
Review and examine life insurance claims; determines whether to return, put on pending, deny, or pay claim. Follows established claim policies and practices to resolve claims and issues. Answer incoming phone calls from claimants and answer any questions in regards to the death claim.
- CLAIM EXAMINER at METLIFE
- CUSTOMER RELATIONS SPECIALIST at THE HARTFORD INSURANCE GROUP
- CUSTOMER SERVICE REPRESENTATIVE at ACS A XEROX COMPANY
- ASSISTANT MANAGER at WALGREENS
2 years, 2 months at this Job
- None - Small Business Management
- None - Business Management
* Daily contact with customers and insurance agents regarding missing information leading to appraisal letters to management regarding my service and professionalism * Strong customer service interaction and working with difficult situations and customers on time sensitive issues * Process annuities for over 1,000 accounts for clients locally and nationally * Review legal documents * Check for fraudulent documents and kept up with fraud regulation Staff Accounting Assistant * Reconcile/Balance accounting spreadsheets and expense reports for 5 different bank accounts * Maintained cash control by data collecting checks, checking for accuracy, transferring money, and completing deposit slips Claim Examiner * Paid Long Term Care and Express claims on Mainframe * Contacted Insurance companies and customers on coverage and handled disputes and negotiations * Acted as a liaison between the insurance analysts and customer * Reviewed medical records for the insurance analysts and coded them * Filing Underwriting Service Representative * Supported three underwriters by prepping the insurance files and acting as a liaison to get any outstanding information that was needed * Checked on lab results and other outstanding medical information on the clients to see if they were insurable and if any further medical information was needed * Received several outstanding appraisals from underwriters for my performance in getting them the information on time
- Document Specialist/Claim Examiner/Underwriting Assistant at Allstate Insurance
12 years at this Job
- Associates Degree in Business - Business/Retail Management
- Bachelor's Degree in Psychology - Various Business
Handle injury and non-injury Commercial Property and Auto claims Complete thorough review of policy and endorsements Investigate coverage questions on Commercial policies Determine liability and negotiate disputed liability Review all loss data and reports Assist with processing on total loss settlements Manage subrogation against third parties and insurers Utilize and work with field service providers Coordinate inspection of damages to obtain appraisals Monitor rental management
- Claim Examiner at 2B Claim Services
- Senior Claim Specialist at State Farm Mutual Insurance
- Senior Claim Processor at State Farm Insurance
- Claim Service Assistant at State Farm Mutual Insurance
2 years, 7 months at this Job
7. Bodily Injury / Litigation Claim Specialist / Claim Representative / Claim Examiner (Auto) Resume
State Farm Insurance Companies Indianapolislis, Indiana Bodily Injury / Litigation Claim Specialist / Claim Representative / Claim Examiner (Auto) Managed/owned 350 complex auto property and bodily injury liability caseload accounts; handled lawsuits, instructed defense attorneys on how to proceed with the defense of the lawsuit, and examined medical records with knowledge of medical terminology, adjudicated fraudulent claims, diagnostic coding and treatments to properly develop a comprehensive injury claim investigation. Negotiated injury claims with Plaintiff Attorneys. Reviewed for recognized indicators of fraud as developed by National Insurance Crime Bureau (NICB). Responsible for 4 state territory (IN, HI, WI and OR) with daily settlement authority of $7,500.00. Select achievements:
• Chosen to conduct side-by-side training and mentoring for new employees on all aspects of the claims handling process, negotiation techniques for arbitration and mediation
• Maintains an 87% or better arbitration win
• Performed SIU duties before the official creation of the Specialty Investigation Unit team in 2012
• Designated company representative to attend mediations & trials as expert examiner and professional witness
• Achieved “On the Spot” award given by manager for going above and beyond to support team and customers
• Handled MCIU projects and associated claims to determine project paths and managed individual PIP, BI, and UM and UIM claims
• Participated in examinations under oath (EUO) and depositions with claimants in addition to attending depositions to determine values for each claim and possibility of upcoming litigation
• Ensured management and insureds remained updated regarding litigation or settlement issues
• Reduced costs associated with long claim resolutions due to litigation by urging attorneys to set timelines for plaintiffs and requesting recurring testimony from physicians for multiple cases
• Resolved numerous cases prior to claim going to trial
• Achieved successful outcomes on cases that went to trial
State Farm Insurance Companies
Bodily Injury / Litigation Claim Specialist / Claim Representative / Claim Examiner (Auto)
Managed/owned 350 complex auto property and bodily injury liability caseload accounts; handled lawsuits, instructed defense attorneys on how to proceed with the defense of the lawsuit, and examined medical records with knowledge of medical terminology, adjudicated fraudulent claims, diagnostic coding and treatments to properly develop a comprehensive injury claim investigation. Negotiated injury claims with Plaintiff Attorneys. Reviewed for recognized indicators of fraud as developed by National Insurance Crime Bureau (NICB). Responsible for 4 state territory (IN, HI, WI and OR) with daily settlement authority of $7,500.00.
- Bodily Injury / Litigation Claim Specialist / Claim Representative / Claim Examiner (Auto) at STATE FARM INSURANCE COMPANIES
28 years, 11 months at this Job
- Bachelor's - Public Affairs / Health Services Administration
- Associate - (SCLA) Designation
• Provides customer service to our insureds.
• Manage the medical portion of the auto insurance claim.
• Review claims to determine casualty.
• Investigate the validity of claims.
• Monitor course of treatments.
- Claim Examiner at Geico
- Paralegal at Rosicki, Rosicki & Associates, P.C
- Paralegal at Mirkin & Gordon
7 months at this Job
- M.S. - Information Systems
- B.A. - History
Claims examiner for several different groups including Molina, GEHA, LACare, Blue Cross Blue shield, Caresource. Paying on Medicare, Medicaid and primary claims. Processing included primary, cob and adjustment claims for all groups and services.
- Claim Examiner II at Firstsource INC
- Claims Examiner III at Cigna Insurance Companies
8 years, 8 months at this Job
- Associate - General study
• Examined both Daily and Catastrophe claims, with the most recent being Heritage Property Insurance; reviewing property field inspection estimates, and other expert's reports regarding the cause of loss and extent of the damage.
• Assigned appropriate reserves to claims and monitoring its adequacy throughout the life of the claim.
• Wrote coverage determination/supplemental response letters and corresponded with insureds, claimants and/or their representatives; to include recorded interviews.
- Home Owner's Claim Examiner at Heritage Property & Casualty Insurance Via Roth Staffing
- Home Owner's Claim Examiner at Olympus Insurance Company
- Temporary-Claims Service Specialist at Criterion Executive Staffing
- Auto Claims Examiner at Allstate Insurance
1 year, 11 months at this Job
- B.A. - Communication Studies
- A.S. - Web/Software Development