ANDRA GULLETTE
State Farm
Dallas,TX
2
Certifications
10
years of professional experience
Claims Adjuster handling automobile and casualty files with a focus on medical record review, policy interpretation, and settlement negotiation. Reviews police reports, treatment records, medical bills, and property damage to assess liability and damages accurately. Protects claim quality through HIPAA compliance and timely resolution of complex claim issues.
Work History
Claims Adjuster, Automobile and Casualty
2 Years 9 Months- Resolve 85% of settlement discussions through fair negotiations that protect company interests.
- Review 45 claim files weekly while applying policy interpretation and HIPAA compliance standards.
- Assess medical records, treatment notes, and bills to determine injury severity and damages owed.
- Investigate police reports, property damage, and witness accounts to evaluate liability and strengthen claim decisions.
- Contact claimants, doctors, specialists, and employers to gather missing details and clarify claim facts.
- Research complex legal questions and insurance regulations to move auto casualty claims toward timely resolution.
- Complete continuing education on auto casualty trends while documenting claim files and maintaining organized records.
Billing Specialist
4 Years 3 Months- Process 50 client invoices per day in CPR+ while keeping billing records current.
- Review claims for coding accuracy and apply ICD-10 standards to submitted billing records.
- Verify insurance coverage, pre-certification, and pre-authorization before procedures or scheduling.
- Coordinate billing communications between patients, billing personnel, and insurance carriers to resolve account questions.
- Maintain HIPAA confidentiality while entering procedure codes, diagnosis codes, and patient details into billing software.
- Train new team members on company policies and accounting systems to support productive daily operations.
Patient Service Specialist
1 Year 4 Months- Processed $0-100 in third-party liability claims for Medicaid and Medicare while coordinating follow-up on appeals.
- Handled 100 patient calls per day, routing questions and complaints to the appropriate medical or administrative staff.
- Verified workers' compensation and insurance coverage, then relayed findings to therapists and support staff.
- Assigned ICD-10 diagnostic codes, reviewed medical records for accuracy, and corrected documentation errors before billing.
- Reviewed claim documentation, forwarded complex cases for investigation, and supported compensability and coverage determinations.
- Managed patient registration, medical reports, and end-of-day closing with accurate data entry and Microsoft Office use.
- Trained employees on best practices and protocols while supporting team productivity and assisting claimants, providers, and clients.
Subrogation Claims Representative
3 Months- Investigated claim details to determine liability and support subrogation recovery decisions.
- Analyzed medical records and billing documents to verify claim validity and recoverable costs.
- Documented claim activity clearly to maintain accurate subrogation files and support case progress.
- Communicated with insurers and internal teams to gather information needed for claim resolution.
- Verified coverage information and policy details to confirm subrogation eligibility.
- Reviewed supporting evidence for liability issues and escalated disputed claims when needed.
- Maintained compliance with confidentiality requirements while handling sensitive claim information.
- Prepared case notes and supporting documents for settlement discussions and recovery outreach.
- Used Microsoft Office to organize correspondence, track claim status, and support reporting tasks.
- Performed data entry for claim updates while maintaining organized and accurate records.
- Assessed case documents for potential fraud indicators and flagged concerns for review.
- Assisted with litigation support by organizing records and preparing requested claim materials.
- Applied insurance regulations to support consistent handling of subrogation claims and related correspondence.
Education
- Medical Billing And Coding
Skills
Claims investigation
Medical record review
Liability assessment
Settlement negotiation
Subrogation recovery
Claims investigation
HIPAA compliance and policy interpretation
CPT and ICD-9 coding
Insurance claims processing and coverage verification
Microsoft Office proficiency
Data entry and ten-key skills
Litigation support
Fraud detection
Claim file documentation
Medical bill auditing
Lien resolution
Insurance regulations
Certification
P&C License All line
Timeline
Claims Adjuster, Automobile and Casualty
State Farm
01.2024 - CurrentRead More
Billing Specialist
AIS Healthcare
10.2019 - 01.2024Read More
Patient Service Specialist
Select Medical
06.2017 - 10.2018Read More
Subrogation Claims Representative
HMS
09.2016 - 12.2016Read More
Sanford
from Medical Billing And Coding
Read More