Served as a temp claims examiner during CAT season for Hurricane Irma and Michael claims, specializing in loss assessments, roof damage and limited interior damage claims. ♦ Provided focused customer service to ensure that each insured's needs were met in a timely manner. Experience with handling customer service inquiries in a high-volume call setting. ♦ Made contact with insureds and agents within 24 hours of claim initiation ♦ Responsible for the entire claims process including verifying coverage, determining liability and requesting payment from the carrier for the insured or a third-party vendor. ♦ Provided administrative support to upper leadership for special projects requiring immediate attention
- Claims Examiner at RYZE Claims Solutions
- Medical Office Practice Manager at Access Health Care, LLC
- Franciscan Physician Network at Provider Credentialist
- Personal Banker at JP Morgan Chase
9 months at this Job
- - Medical Billing
Supervisor: Ben Summers Claims examiner which includes reimbursement of telephone bills for Verizon retirees.
- Claims Examiner at HealthSmart Benefit Solutions
- Cashier and Customer Service Desk at Target
- Third Part Administrator at Wells Fargo
- Manager at Pizza Hut
7 years at this Job
As a claims examiner for Allianz my job is to review claims to ensure that the adjusters and claimants have followed all of the necessary guidelines. I normally check for overpayments, underpayments, and other irregularities.
- Claims Examiner at Allianz
- Customer Service Representative at T-Mobile
- Sales Lead at Underground by Journeys
- Customer Service Representative at General Dynamics
4 months at this Job
- - Interdisciplinary Studies
Held several positions within the Claims Department including Claims Technical Coordinator, Claims Adjustment Examiner, Claims Customer Service Examiner and Senior Claims Examiner. Was also a member of Change Management and Work Flow groups. Knowledge of medical and dental claim forms and general medical terminology.
- Claims Examiner at HealthPartners
- Cashier at Cub Foods, Inc
21 years, 8 months at this Job
- Word Processing Secretary Diploma - Word Processing
Ward Kraft 2500 Campbell Drive 2401 Cooper Street Ft Scott KS 66701 Ft Scott KS 66701 May 2015-Current November 2009 - May 2015 Claims Examiner 2015 - Current. Processed for one major medical group. Specialized in outpatient claims on ub forms. Also knowledgeable on hcfas. Comfortable on medicare and medicaid.
- Claims Examiner at FirstSource Solutions
- Customer Service at Art Department
3 years, 8 months at this Job
- High School Diploma
- Associate of Science degree - theater
Senior Claims Examiner
Graduate of Sedgwick's IAP Workers Compensation Trainee Program
● Communicates claim activity and processing with claimant and client on regular basis
● Manage claims through investigating and gathering information to determining exposure of claim
● Monitors medical records and works with designated nurse for return to work status of claimants
● Manages litigated claims and negotiates settlement within authority limits
- Claims Examiner at Sedgwick CMS
- Workers Compensation Specialist at Ford Motor Company
- Claims Examiner at CCMSI
4 years, 11 months at this Job
- Master of Science - Healthcare Administration
- Bachelor of Science - Health Service
• I have my certification in the state of California with the Office of Industrial Relations- Self Insurance plan, as a California Claims Examiner.
• This jobs entails the following:
• Determine compensability and issue benefits on Worker's Compensation claims.
• Maintain communication with a variety of professional people, including but not limited to doctors, attorneys, providers and employers.
• Maintain exceptional customer service.
• Meet deadlines set by company and the state of California.
- Claims Examiner at Sedgwick
- Server at The Melting Pot
- Cashier/Accountant at Hanlees Toyota Dealership
- File clerk at Hanlees Nissan Dealership
1 year at this Job
- B.A - Psychology
Current: December 2016 - Present
LTD Claims Examiner 1
• Process claims within departmental and regulatory guidelines.
• Review eligibility, covered monthly earnings, Total Disability, offsets and pre-existing investigations.
• Develop, implement and modify disability management plan to establish strategy and manage outcome.
• Documents claim file actions and telephone conversations appropriately.
• Pro-actively communicates with claimants, policyholders, and physicians
• Fully investigates all relevant claim issues.
• Responds to customer service issues within required time frames.
• Use of Microsoft office frequently (word, excel)
• Collaborates with team members and management
- Claims Examiner at Reliance Standard Life Insurance
- Enrollment Support Specialist at BioTelemetry, Inc
- Inventory Technician/Distribution Center Associate at Lilly Pulitzer, Inc
2 years, 1 month at this Job
- Bachelor of Arts - History
James River Insurance Company Richmond, VA 2017-Present Claims Examiner Manage approximately 102 pending claims, consisting of residential and commercial construction defect claims, hired non-owned auto claims. Address coverage issues prevalent in commercial general liability policies through timely communications with coverage counsel and insureds. Analyze liability and damages through occasional use of independent adjusters and appropriate defense counsel. Ensure proper reserves on claims and successfully process claims to closure utilizing best practices. Prepare reports to management and attend mediations when appropriate in effort to resolve claims. Maintain current licenses across several states by attending continuing education seminars.
- Claims Examiner at James River Insurance Company
- Settlement Agreement Liaison at Brown Greer
- Sole Practitioner/ Non-Profit Staff Attorney at Marsha Green Attorney at Law
- Associate Attorney at Carter & Cates, APLC
1 year, 11 months at this Job
- Juris Doctorate
- Bachelors of Science - Accounting
654 Luis Muñoz Rivera Avenue San Juan, Puerto Rico 00918 United States 01/2015 - Present Hours per week: 40 Claims Examiner Duties, Accomplishments and Related Skills: Analyze complaints received for the government health system Award payments or denials according to established procedures Validate information on documents, eligibility dates or contracts of suppliers with the corresponding departments Analyze corrected claims sent by suppliers and process them Supervisor: Juan Ramos (787-200-3300) Okay to contact this Supervisor: Yes MMM (Medicare y Mucho Mas) # 411 Segarra street, Bechara Industrial Park, Ave.Kennedy marginal, San Juan San Juan, PR 00920 United States
- Claims Examiner at Molina Healthcare of Puerto Rico
- Enrollment Specialist at
- Customer Service Representative at Triple S Advantage
- Enrollment Specialist at MCS Classicare
4 years at this Job
- Bachelor's Degree