Summary
Overview
Work History
Education
Skills
Timeline
Adjuster Licenses
References
Quote
Software
Languages
Work Availability
Interests
Generic
Portia Nicole

Portia Nicole

Virtual Property Estimator
Dallas Fort Worth Metropolex,US

Summary

Property Estimate Reviewer and Supplemental Estimate & Supplement Reviewer with eye for detail and passion for crafting stories. Pursuing full-time role that presents professional challenges and leverages interpersonal skills, effective time management, and problem-solving expertise. Results oriented achiever with proven ability to exceed targets and drive success in fast-paced environments. Combines strategic thinking with hands-on experience to deliver impactful solutions and enhance organizational performance. Tech-savvy innovator with hands-on experience in emerging technologies and passion for continuous improvement. Skilled in identifying opportunities for technological enhancements and implementing effective solutions. Adept at leveraging new tools and methods to solve problems and enhance productivity. Excels in adapting to fast-paced environments and driving technological advancements. Organized and dependable candidate successful at managing multiple priorities with a positive attitude. Willingness to take on added responsibilities to meet team goals. Possesses versatile skills in project management, problem-solving, and collaboration. Recognized for adaptability and proactive approach in delivering effective solutions. Poised to contribute to team success and achieve positive results. Ready to tackle new challenges and advance organizational objectives with dedication and enthusiasm. Recognized for taking proactive approach to identifying and addressing issues, with focus on optimizing processes and supporting team objectives

Overview

10
10
years of professional experience

Work History

Independent Virtual Estimator

Nationwide
04.2024 - Current
  • Analyze and calculate field measurements, survey plans, and plot plans to create proposals and process work orders.
  • Analyze buildings to prepare estimates for Property Claims.
  • Analyze designs and perform accurate cost analysis.
    Track project costs and expenses to monitor progress and identify and mitigate deviations from original estimate.
  • Collaborate with other departments and contractors to access all necessary information and expertise to create comprehensive estimates.
  • Gather cost and material data for accurate and up-to-date information on material and labor costs.
    Identify areas for cost saving to help increase profitability and lower client costs.
  • Review and approve invoices and change orders to monitor project expenses and reflect any change to scope in project budget.
  • Utilize Software to create initial & supplemental estimates
  • Utilize Graphic Estimating to Complete Accurate Estimates
  • Create Estimates for Insureds to easily understand and interpret line items
  • Provide accurate estimates by defining scope, timelines, potential setbacks, and limitations.
  • Prepare estimates used by management for purposes such as planning, organizing, and scheduling work.
  • Collaborate with contractors to obtain necessary information for preparing cost estimates.
  • Research construction cost trends to stay up-to-date with industry developments and changes.
  • Analyze plans and specifications to identify scope and cost of projects.
  • Deliver consulting services to advise clients on cost-saving strategies and best practices.
  • Stay current with industry regulations and standards to produce cost estimates in compliance with all relevant laws.
    Prepare & Review Supplemental Revision Requests by Reviewing Prior Inspections, Current & Prior Estimates, Invoices and Proposals from Contractors & Insureds for payment authority requests
  • Evaluate subcontractor bids to obtain best value for projects.
  • Gathered data on materials, labor and equipment costs to determine total costs of projects.
  • Conducted Virtual Inspections to inspect damages for extending coverage and writing estimates for expedited indemnity payments.
  • Utilized cost-estimating software to streamline estimating processes and produce accurate and reliable estimates.
    Reviewed and approved invoices and payments, verifying accuracy of expenses.
  • Analyze & Inspect Exterior, Roof & Interior Structural Damages to Property for Catastrophe Homeowner Claims

Senior Claims Examiner

Progressive Insurance Claims
05.2022 - 11.2023
  • Investigated properties to determine extent of damage and estimate repair costs.
  • Researched claims and incident information to deliver solutions and resolve problems.
  • Interviewed claimants and witnesses to gather factual information.
  • Examined photographs and statements.
  • Handled complaints and grievances using negotiating and problem-solving skills.
  • Identified insurance coverage limitations with thorough examinations of claims documentation and related records.
  • Assisted homeowners by coordinating vendor services, emergency repair, cleaning and contractors.
  • Conducted day-to-day administrative tasks to maintain information files and process paperwork.
  • Delivered exceptional customer service to policyholders by communicating important information and patiently listening to issues.
  • Examined claims forms and other records to determine insurance coverage.
  • Clarified coverage of losses to policyholders and provided assistance in itemizing damages and finding alternative living arrangements.
  • Read over insurance policies to ascertain levels of coverage and determine whether claims would receive approvals or denials.
  • Analyzed information gathered by investigation and reported findings and recommendations.
  • Investigated and assessed damage to property and reviewed property damage estimates.

Independent Property Adjuster

USAA Insurance
05.2021 - 12.2022
  • Investigated claims by reviewing policy contracts to determine claim coverage based on cause and facts of loss.
  • Carefully review claim information to verify accuracy and avert fraudulent claims.
  • Identify insurance coverage limitations with thorough examinations of claims documentation and related records.
  • Coordinated and managed field investigations, outside engineers, contractors and cause and origin experts.
  • Proven success working within tight deadlines and fast-paced environment.
  • Identified issues, analyzed information and provided solutions to problems.
  • Resolve problems, improved operations and provided exceptional service.
  • Assist with day-to-day operations, working efficiently and productively with all team members.

Independent Complex Insurance Examiner

Kin Insurance
Fort Lauderdale, FL
05.2021 - 01.2022
  • Identified insurance coverage limitations with thorough examinations of claims documentation and related records.
  • Examined claims forms and other records to determine insurance coverage.
  • Clarified coverage of losses to policyholders and provided assistance in itemizing damages and finding alternative living arrangements.
  • Assisted homeowners by coordinating vendor services, emergency repair, cleaning and contractors.
  • Reviewed new files to determine current status of injury claim and to develop plan of action.
  • Researched claims and incident information to deliver solutions and resolve problems.
  • Conducted day-to-day administrative tasks to maintain information files and process paperwork.
  • Analyzed information gathered by investigation and reported findings and recommendations.
  • Investigated and assessed damage to property and reviewed property damage estimates.
  • Conducted comprehensive interviews of witnesses and claimants to gather facts and information.
  • Delivered exceptional customer service to policyholders by communicating important information and patiently listening to issues.

Independent Insurance Adjuster

State Farm
Coppell, TX
08.2021 - 06.2022
  • Interviewed agents and claimants to correct errors or omissions and investigate questionable claims.
  • Examined claims forms and other records to determine insurance coverage.
  • Reviewed and analyzed suspicious and potentially fraudulent insurance claims.
  • Followed up with insured individuals regarding premium and deductibles payments.
  • Documented all investigation activity and presented reports to management.
  • Evaluated insurance policies and analyzed damages to determine coverage.
  • Eliminated claimant, premium and provider fraud.
  • Analyzed information gathered by investigations to report findings and recommendations.

Independent Insurance Property Claims Examiner

Liberty Mutual
Addison, TX
12.2019 - 05.2021
  • Prepared summaries of damage, payments and policy coverage.
  • Researched claims and incident information to deliver solutions and resolve problems.
  • Verified insurance claims and determined fair amount for settlement.
  • Investigated and processed property insurance claims for policyholders.
  • Finalized investigation files for insurance claim payment release.
  • Conducted day-to-day administrative tasks to maintain information files and process paperwork.
  • Incorporated time management and detailed oriented objectives to achieve action plans and strategies.
  • Examined photographs and statements.
  • Interviewed claimants and witnesses to gather factual information.
  • Investigated properties to determine extent of damage and estimate repair costs.
  • Handled complaints and grievances using negotiating and problem-solving skills.
  • Reviewed and analyzed suspicious and potentially fraudulent insurance claims.
  • Examined claims forms and other records to determine insurance coverage.
  • Investigated and assessed damage to property and reviewed property damage estimates.
  • Investigated legal issues pertaining to claims.
  • Organized, planned, and documented materials for claims.
  • Maintained claims data in systems.
  • Reported to management on customer problems, field conditions, safety issues and policy problems.
  • Evaluated insurance policies and analyzed damages to determine coverage.
  • Evaluated evidence with ultimate goal of creating positive outcomes for client's claims.
  • Substantiated legitimate claims and denied unjustified claims.
  • Prepared documents for managers or legal personnel.
  • Collected information from customers to complete claims and legal files.
  • Analyzed information gathered by investigations to report findings and recommendations.
  • Documented all investigation activity and presented reports to management.
  • Monitored-clients caseload for each quarter.
  • Handled calls from customers about claim processes.
  • Reviewed field inspections and coordinated all insurance claim audits.
  • Negotiated settlement agreements to resolve disputes.
  • Answered customer questions regarding deductibles.
  • Verified accuracy of records to maintain accuracy of records database.
  • Directed and coordinated various investigations conducted by field investigation team.
  • Organized, planned, and documented materials for Property claims.
  • Followed up on potentially fraudulent claims initiated by claims representatives.
  • Negotiated settlement agreements to resolve disputes.
  • Drafted investigative reports covering phases of investigation in each case.

Medicare Claims Processor

Lincare Healthcare
Oklahoma City, OK
12.2017 - 12.2018
  • Maintained strict confidentiality with all personal data as per company guidelines.
  • Viewed reports regularly to make sure processing was conducted efficiently.
  • Evaluated original investigation reports and documents to resolve secondary concerns.
  • Reviewed questionable claims by conducting claimant interviews to correct omissions and errors.
  • Identified insurance coverage limitations with thorough examinations of claims documentation and related records.
  • Read over insurance policies to ascertain levels of coverage and determine whether claims would receive approvals or denials.
  • Corrected codes to properly classify claims.
  • Delivered exceptional customer service to policyholders by communicating important information and patiently listening to issues.
  • Examined claims forms and other records to determine insurance coverage.
  • Resolved complex, severe exposure claims using high service oriented file handling.
  • Analyzed information gathered by investigation and report findings and recommendations.
  • Researched claims and incident information to deliver solutions and resolve problems.
  • Conducted day-to-day administrative tasks to maintain information files and process paperwork.
  • Collected information from customers to complete claims and legal files.
  • Verified accuracy of records to maintain accuracy of records database.
  • Negotiated settlement agreements to resolve disputes.
  • Followed up on potentially fraudulent claims initiated by claims representatives.
  • Analyzed information gathered by investigation and reported findings and recommendations.
  • Managed large volume of medical claims on daily basis.
  • Maintained knowledge of benefits claim processing, claims principles, medical terminology and procedures and HIPAA regulations.
  • Used administrative guidelines as resource or to answer questions when processing medical claims.
  • Reviewed provider coding information to report services and verify correctness.
  • Responded to correspondence from insurance companies.
  • Paid or denied medical claims based upon established claims processing criteria.
  • Reported policy changes and company conditions affecting customer satisfaction.
  • Verified accuracy of records to maintain accuracy of records database.
  • Incorporated objectives to achieve action plans and strategies.
  • Maintained claims data in systems.
  • Documented information gathered in field and uploaded data to company database for efficient processing.
  • Handled calls from customers about claim processes.
  • Estimated quantifiable characteristics of durable medical products.
  • Resubmitted claims after editing or denial to achieve financial targets and reduce outstanding debt.
  • Verified client information by analyzing existing evidence on file.
  • Generated, posted and attached information to claim files.
  • Checked documentation for accuracy and validity on updated systems.
  • Assured timely verification of insurance benefits prior to patient procedures or appointments.
  • Maintained strong knowledge of basic medical terminology to better understand services and procedures.
  • Coordinated with contracting department to resolve payer issues.
  • Posted payments to accounts and maintained records.
  • Prepared insurance claim forms or related documents and reviewed for completeness.
  • Modified, updated and processed existing policies.
  • Processed and recorded new policies and claims.

Senior Claims Reimbursement Specialist

AmerisourceBergen
Frisco, TX
12.2016 - 12.2017
  • Made contact with insurance carriers to discuss policies and individual patient benefits.
  • Modified, updated and processed existing policies.
  • Assured timely verification of insurance benefits prior to patient procedures or appointments.
  • Maintained confidentiality of patient finances, records and health statuses.
  • Processed and recorded new policies and claims.
  • Verified client information by analyzing existing evidence on file.
  • Coordinated with contracting department to resolve payer issues.
  • Maintained strong knowledge of basic medical terminology to better understand services and procedures.
  • Communicated effectively with staff members of operations, finance and clinical departments.
  • Reviewed outstanding requests and redirected workloads to complete projects on time.
  • Posted payments to accounts and maintained records.
  • Prepared insurance claim forms or related documents and reviewed for completeness.
  • Checked documentation for accuracy and validity on updated systems.
  • Carried out administrative tasks by communicating with clients, distributing mail and scanning documents.
  • Generated, posted and attached information to claim files.
  • Resubmitted claims after editing or denial to achieve financial targets and reduce outstanding debt.
  • Determined appropriateness of payers to protect organization and minimize risk.

Health Insurance Claims Adjudicator & Clinical Adv

Humana
Irving, TX
12.2014 - 12.2016
  • Analyzes and processes complex or technically difficult workers' compensation claims by investigating and gathering information to determine the exposure on the claim; manages claims through well-developed action plans to an appropriate and timely resolution.
  • Negotiates settlement of claims within designated authority.
  • Calculates and assigns timely and appropriate reserves to claims; manages reserve adequacy throughout the life of the claim.
  • Calculates and pays benefits due; approves and makes timely claim payments and adjustments; and settles clams within designated authority level.
  • Prepares necessary state fillings within statutory limits.
  • Manages the litigation process; ensures timely and cost effective claims resolution.
  • Coordinates vendor referrals for additional investigation and/or litigation management.
  • Uses appropriate cost containment techniques including strategic vendor partnerships to reduce overall cost of claims for our clients.
  • Manages claim recoveries, including but not limited to: subrogation, Second Injury Fund excess recoveries and Social Security and Medicare offsets.
  • Reports claims to the excess carrier; responds to requests of directions in a professional and timely manner.
  • Communicates claim activity and processing with the claimant and the client; maintains professional client relationships.
  • Ensures claim files are properly documented and claims coding is correct.
  • Refers cases as appropriate to supervisor and management.
  • Supported individuals with legal, physical or mental health concerns in dealing with routine needs and complex problems.
  • Organized supporting documentation for individuals under evaluation and coordinated paperwork transfers to correct staff members.
  • Onboarded and monitored program participants and guided each through entry-level stages.
  • Worked effectively with fellow team members to coordinate effective solutions to any question or concern.
  • Conducted pre-screening activities to help determine eligibility for behavioral health advocacy.
  • Delivered friendly service for needs associated with behavioral health advocacy, providing expert support in every interaction.
  • Managed required paperwork to help individuals sign up for behavioral health advocacy services.
  • Reached out to individuals eligible for services to solicit applications and offer assistance.
  • Maintained positive relationships with service providers relevant to behavioral health program operations.
  • Collaborated on program operations and relayed participant feedback for improvements.
  • Compiled socioeconomic data for specific program eligibility determinations and large-scale research purposes.
  • Determined needed and relevant interventions based on each client's cognitive abilities and current needs.
  • Worked with clients to improve life choices and maximize benefits of programs.
  • Spoke with senior citizen groups to expand community engagement and program outreach.
  • Helped social workers build, coordinate and lead programs supporting individuals with behavioral health concerns.
  • Identified service gaps and located needed housing and work placement resources for individuals.
  • Oversaw day-to-day activities of members in behavioral health facilities and home.
  • Coordinated referrals and direct support for behavioral health clients.
  • Detailed program operations and participant activities with comprehensive record keeping.
  • Improved clients' coping with routine life activities such as food budgeting and rental payments.

Education

Master of Science - Public Health

Kaplan University
Davenport, IA
10.2015

Bachelor Of Health Science - Health Administration

Texas Southern University
Houston, TX
12.2011

Skills

  • Exemplary Compliance Acknowledgement Awards
  • Quarter File Review Audits; 95% Accuracy
  • Quality File Review Audits Quarterly for 2020-2024
  • Policy investigations
  • Valuation knowledge
  • Damage itemization
  • Underwriting knowledge
  • Hail and wind damage specialist
  • Insurance policy coverage knowledge
  • Negotiation and mediation skills
  • Risk management
  • Interior water damage background
  • Coverage determination
  • Analytical and interpretive skills
  • Excellent negotiation skills
  • Benefits review
  • Claims
  • Familiar with fraud statutes
  • Estimate Preparation
  • Cost Estimation
  • Project estimation and bidding
  • Cost Reporting
  • Drywalling
  • Scope development
  • Roofing
  • Construction management
  • Residential construction

Timeline

Independent Virtual Estimator

Nationwide
04.2024 - Current

Senior Claims Examiner

Progressive Insurance Claims
05.2022 - 11.2023

Independent Insurance Adjuster

State Farm
08.2021 - 06.2022

Independent Property Adjuster

USAA Insurance
05.2021 - 12.2022

Independent Complex Insurance Examiner

Kin Insurance
05.2021 - 01.2022

Independent Insurance Property Claims Examiner

Liberty Mutual
12.2019 - 05.2021

Medicare Claims Processor

Lincare Healthcare
12.2017 - 12.2018

Senior Claims Reimbursement Specialist

AmerisourceBergen
12.2016 - 12.2017

Health Insurance Claims Adjudicator & Clinical Adv

Humana
12.2014 - 12.2016

Master of Science - Public Health

Kaplan University

Bachelor Of Health Science - Health Administration

Texas Southern University

Adjuster Licenses

National Provider No: 16868183

References

Telephone Contact Can Be Provided Upon Request

Quote

Your most unhappy customers are your greatest source of learning.
Bill Gates

Software

Verisk

X8

Xactanalysis

Guidewire

Languages

English
Native or Bilingual

Work Availability

monday
tuesday
wednesday
thursday
friday
saturday
sunday
morning
afternoon
evening
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Interests

Property

Policy

Compliance

Virtual Estimation

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Portia NicoleVirtual Property Estimator