Andrea Brown
Dallas,TX
Summary
Detail-oriented claims adjuster with a proven track record in claims investigation and settlement negotiation. Known for maintaining regulatory compliance and delivering exceptional customer service.
Overview
11
11
years of professional experience
Work History
Claims Adjuster
GEICO
Richardson, TX
10.2025 - Current
- Evaluated insurance claims for accuracy and completeness.
- Collaborated with policyholders to gather necessary documentation.
- Investigated claim details by reviewing records and conducting interviews.
- Assessed damages and determined appropriate settlements within guidelines.
- Communicated decisions clearly to clients, ensuring understanding of outcomes.
- Maintained accurate records of claims processed in internal systems.
- Negotiated favorable settlements with claimants, attorneys, and other insurance carriers to minimize financial risk for the company.
- Examined claims forms and other records to determine insurance coverage.
- Verified insurance claims and determined fair amount for settlement.
- Maintained compliance with state regulatory requirements through meticulous documentation and adherence to company policies.
- Conducted thorough investigations of complex insurance claims, gathering evidence and analyzing relevant documentation.
- Provided exceptional customer service during emotionally difficult situations for policyholders following accidents or natural disasters.
- Reviewed police reports, medical treatment records, and physical property damage to determine extent of liability.
- Answered customer questions regarding deductibles.
- Conducted comprehensive interviews of witnesses and claimants to gather facts and information.
- Improved claim resolution times by efficiently managing a caseload of 50+ claims per month.
- Evaluated coverage accurately by interpreting complex insurance policies and applying them to specific claim scenarios.
- Identified potential fraud indicators early in the investigation process, protecting company assets from potential losses due to fraudulent activity.
- Read over insurance policies to ascertain levels of coverage and determine whether claims would receive approvals or denials.
- Maintained contact with claimants and attorneys to determine treatment status.
- Reviewed and evaluated auto claims to determine validity and coverage under policy guidelines.
- Advised clients on claim procedures, ensuring clarity and understanding of next steps.
- Issued payouts to claimants.
Prior Authorization Specialist
Parallon
Work From Home
12.2021 - 04.2024
- Processed prior authorization requests efficiently, ensuring compliance with regulatory requirements.
- Collaborated with healthcare providers to gather necessary documentation for approvals.
- Utilized electronic health record systems to track and manage authorization statuses.
- Analyzed denial reasons to implement corrective measures and improve approval rates.
- Developed streamlined workflows that reduced processing times for authorizations.
- Maintained thorough knowledge of insurance plan requirements, facilitating accurate and timely completion of authorization forms.
- Reached out to insurance carriers to obtain prior authorization for testing and procedures.
- Responded to inquiries from healthcare providers regarding prior authorization requests.
- Reduced turnaround time for prior authorization requests by utilizing electronic submission methods.
Status Change
Parallon
Work From Home
04.2018 - 12.2021
- Self-motivated, with a strong sense of personal responsibility.
- Worked effectively in fast-paced environments.
- Skilled at working independently and collaboratively in a team environment.
- Proven ability to learn quickly and adapt to new situations.
- Paid attention to detail while completing assignments.
- Organized and detail-oriented with a strong work ethic.
Registrar
Medical City Green Oaks Hospital
Dallas
09.2015 - 04.2018
- Managed patient registration processes, ensuring accurate data entry and compliance with healthcare regulations.
- Coordinated insurance verification and authorization, enhancing efficiency in patient admissions.
- Developed training materials for new registrars, fostering knowledge transfer and staff onboarding.
- Implemented process improvements to reduce registration wait times and increase patient satisfaction.
- Updated computer system with latest information to keep records current and accurate.
- Developed and implemented registration policies, procedures and timelines for smooth administration processes.
Education
No Degree -
The Adjuster School
Katy04-2023
High School Diploma -
David W Carter
Dallas05-2008
Skills
- Critical thinking
- Claims investigation
- Active listening
- Highly motivated
- Claims processing
- Decision-making
- Settlement negotiation
- Regulatory compliance
- Quality control
- Policy investigations
- Best practices implementation
- Texas claims adjuster license
- CCC reports
- Automobile claims specialist
- Medical coding
- Microsoft publisher
- Customer service
- Problem-solving
- Attention to detail
- Multitasking and organization
- Empathy and patience
- Conflict resolution
- Ethical judgment
- Liability assessment
- Claims investigations
- Evidence reviews
- Customer service and support
- Computer skills
- Liability determination
- Claims
- Coverage determination
- Settlement negotiations
- Payment processing
Timeline
Claims Adjuster
GEICO
10.2025 - Current
Prior Authorization Specialist
Parallon
12.2021 - 04.2024
Status Change
Parallon
04.2018 - 12.2021
Registrar
Medical City Green Oaks Hospital
09.2015 - 04.2018
No Degree -
The Adjuster School
High School Diploma -
David W Carter