Amonie Clay
US Department of the Navy
Chesapeake,VA
1
Language
10
years of professional experience
Results-driven claims professional with extensive experience adjudicating complex disability and benefits claims within the federal government. Expertise in reviewing medical and legal documentation, interpreting policies and regulations, conducting detailed investigations, and making accurate eligibility determinations. Recognized for exceptional analytical abilities, meticulous attention to detail, and delivering high-quality customer service while managing a high-volume caseload. Proven track record of collaborating with cross-functional teams, maintaining confidentiality, and ensuring compliance with federal standards. Holds an active secret security clearance and seeks to leverage investigative and claims management expertise in a claims adjuster or related insurance position.
Work History
Claims Examiner
3 Years- You will analyze and evaluate all documentation and supporting evidence surrounding a claimed loss to ensure that all necessary information, evidence and forms needed for prompt and just disposition.
- Developed data processes and standards ensuring integrity and accuracy of data and dashboards.
- You will analyze Government Bills of Lading, tenders of service, tariffs and other contractual liability in accordance with applicable regulations and directives.
- You will use an internal claims database to track and manage assigned claims.
- Develop data processes and standards to ensure the integrity and accuracy of data and dashboards.
- You will review offers of settlement and compromise from carriers as dictated by governing regulations and prudent judgment.
- Annotated files to reflect decision-making and prepared summaries of evidence to refer the file to the Supervisory Claims Examiner.
Service Advisor
1 Year 4 Months- Assists the Service Consultants in managing customer needs throughout the entire service process, including writing Repair Orders, coordinating check-in and delivery processes, building and communicating repair estimates, following up on the progress of the repairs, contacting customers regarding the changes in estimated repair time, and obtaining proper authorization prior to performing repairs.
- Advised customers on vehicle maintenance and care according to manufacturers’ specifications, enhancing customer understanding of service importance.
- Met customer needs through consistent application of Winners Edge Service Process (WESP), promoting a structured service experience.
- Ensures customer needs are met through consistent use of the Winners Edge Service Process (WESP).
- Advises customers on the care of their cars and the value of maintaining their vehicles in accordance with manufacturers’ specifications.
- Maintains a safe work environment.
- Understands, keeps abreast of, and complies with federal, state and local regulations that affect service operations, such as hazardous waste disposal, OSHA right-to-know, etc.
- Conducted satisfaction calls to customers rating below 100% on surveys, addressing concerns to ensure complete satisfaction with Service and Parts Departments.
- Handled various projects and responsibilities designated by management.
Senior Benefits Solutions Specialist
1 Year 3 Months- Support clients by processing their Benefits enrollment data with a high level of accuracy and quality while ensuring Federal privacy and security compliance inbound and outbound file testing.
- Coordinate with internal partners and third-party vendors to ensure successful transmission of data files in compliance with established federal enrollment reporting legalities.
- Identified, researched, analyzed, and resolved Benefits enrollment data issues to enhance client satisfaction.
- Maintained process documentation and tracked activity details for assigned clients to ensure compliance and accuracy.
- Tracked information and trends to identify and implement improvements in Benefits enrollment processes.
- Provide recommendations by utilizing ADP TS HR and Benefit products and services, including but not limited to, employee handbooks, job descriptions and benefits administration, to maximize client satisfaction and retention.
- Maintain process documentation and activity tracking details for assigned clients.
- Evaluate client’s current HR and Benefit practices.
- Analyzed processes to identify gaps and inefficiencies in workflow.
- Serve as an expert to customers supporting ADP’s most complex products/technologies.
- Provide recommendations by utilizing ADP TS HR and Benefit products and services, including but not limited to, employee handbooks, job descriptions and benefits administration, to maximize client satisfaction and retention.
Data Analyst
2 Years- Integrated understanding of business needs and processes to implement effective documentation and display methodologies.
- Act as the lead for report writing and data analysis.
- Independently analyzes data gathered to identify gaps and map process/procedures.
- Analyzed data to identify gaps and mapped processes and procedures for improved operational clarity.
- Gather data from automated systems to analyze trends of recurring discrepancies.
- Drives results by documenting findings and prepares business recommendations and improvements.
- Defines business solutions using business and knowledge management expertise.
- Resolved complex issues independently by analyzing root causes and implementing solutions. and has latitude to solve complex problems.
- Applies project management skills with short- and long-term projects simultaneously.
- Determines the cause of record imbalances through collection, analysis, and evaluation of factors contributing to the inventory adjustment.
- Acts as the lead for report writing and data analysis.
- Generates the Financial Liability Investigation of Property Loss (FLIPL) Report in accordance with agency policy and procedures as appointed in writing by the proper authority.
- Develops recommendations for new procedures, which correct or prevent errors.
- Understood and promoted the corporate mission by aligning daily activities with company values., vision, value statements standards, policies, procedures, operating instructions, confidentiality standards, and the code of ethical behavior.
- Conducts project meetings and proposes the best method to present content.
- Generated the Financial Liability Investigation of Property Loss (FLIPL) Report in accordance with agency policy and procedures.
- Independently researches and organizes policies, processes and procedures.
- Identifies and initiates new procedures to reduce inventory record error rate, streamline inventory processes, and comply with agency guidance.
- Conducts operational and systemic studies to identify causes contributing to physical inventory and location inaccuracies and validates data compiled using various ADP systems to resolve record accuracy problems.
- Initiated new procedures that reduced inventory record error rates and streamlined inventory processes in compliance with agency guidance.
Property Claims Adjuster
2 Years 6 Months- Manage assigned claims caseload composed of claims with complex damages including specialty claims. Updates initial reserve levels.
- Determines and negotiates complex claims settlement.
- Investigates claim damages by conducting research from various sources including the insured, third parties, and external resources.
- Partnered with vendors and internal business partners to facilitate complex claims, ensuring compliance through appropriate documentation and external regulatory coordination.
- Communicates with insured about coverage or any issues that involve additional information or considerations regarding settlement amount.
- Maintains accurate and current claim file documentation throughout the claims process for complex claims.
- Served as a resource for less experienced staff, providing informal coaching.
- Identified coverage concerns and reviewed prior loss history to create Special Investigation Unit (SIU) referrals, analyzing complex policy terms and contingencies to determine appropriate coverage.
- Communicated with insured regarding coverage issues and additional information affecting settlement amounts, fostering transparency and understanding.
- Provides general claims support by reviewing and processing claims.
- Calculates other insurance and benefits.
- Participates in meetings to share, discuss, and solution for question or error trends, as well as potential process improvements.
- Provides general claims support by reviewing and processing claims.
- Calculates other insurance and benefits.
- Participates in meetings to share, discuss, and solution for question or error trends, as well as potential process improvements.
- Ensures risks associated with business activities are effectively identified, measured, monitored, and controlled.
- Follows written risk and compliance policies and procedures for business activities.
- Makes recommendations to management for settlement amounts outside of authority limits.
- Identifies and manages existing and emerging risks that stem from business activities and the job role.
Education
High School Diploma
Skills
Claims analysis
Claims processing
Data Analyst
Data entry
Regulatory compliance
Project Management
Microsoft Office
Detail oriented
Excellent time management
Team player
Languages
English
Native or Bilingual
Timeline
Claims Examiner
US Department of the Navy
08.2023 - CurrentRead More
Service Advisor
Checkered Flag Honda
03.2022 - 07.2023Read More
Senior Benefits Solutions Specialist
ADP
12.2020 - 03.2022Read More
Data Analyst
Citi Bank
12.2018 - 12.2020Read More
Property Claims Adjuster
USAA
06.2016 - 12.2018Read More
Grassfield High School
High School Diploma
Read More