Angelia Moore
Memphis,TN
Summary
Secure a responsible career opportunity to fully utilize my training and skills, while making a significant contribution to the success of the company. Ethical Auto Claims Adjuster with excellent customer service skills to take on multiple cases while meeting strict deadlines. Adept at determining the level of loss for auto claims cases and deciding on a fair compensation for clients. Strong organizational and communication traits.
Overview
29
29
years of professional experience
Work History
Auto Claims Adjuster
AAS
08.2019 - 08.2023
- Auto Shield
- Review claims for proper diagnosis and determine appropriate coverage as needed Claims handling, including gathering of labor time and cost, parts costs, enter information into system, set-up claim in system with notes, reasons for approval/denial; monitor claims through completion Knowledgeable of automotive parts, repairs, car rentals and towing to ensure proper administration and handling Review all technical issues for accuracy of diagnosis, repairs, and proper repair procedures Perform investigation of unusual claims as requested by management by talking to customers, home service providers or any other involved parties
- Ensure complete and sound claim approvals, legal reviews, and investigations when necessary Manage employees' attendance, timesheets, and metrics
- Managing the workflow of employees Manage current and outstanding open claims Appraise and help develop procedures to improve accountability and ease workflow issues
- Issued payouts to claimants.
- Documented all findings in concise reports.
- Examined photographs and surveillance and any other documents relating to claims.
- Negotiated with claimants to settle claims.
- Kept current on insurance regulations, laws, policies and procedures.
- Reviewed police reports, photographs and other documentation to gain complete understanding of accident.
- Coordinated with local body shops to assign repair jobs and obtained rental vehicles for customers for duration of restoration process.
- Enhanced customer satisfaction by delivering honest advice to policyholders in regards to repair work and body shop processes.
- Carried and managed consistently heavy project workload through exemplary organizational, time management and collaboration talents.
- Identified suspicious claims, escalating issues to supervisor for further investigation and analysis.
- Successfully negotiated settlements with claimants and insurers.
- Assessed complex claims and accurately determined value of damages.
- Analyzed complex data and prepared accurate and comprehensive reports for clients.
- Created detailed assessments of damages to property and vehicles.
- Skilled at working independently and collaboratively in a team environment.
- Self-motivated, with a strong sense of personal responsibility.
- Proven ability to learn quickly and adapt to new situations.
- Worked well in a team setting, providing support and guidance.
- Worked effectively in fast-paced environments.
- Managed time efficiently in order to complete all tasks within deadlines.
- Demonstrated respect, friendliness and willingness to help wherever needed.
- Excellent communication skills, both verbal and written.
- Passionate about learning and committed to continual improvement.
- Proved successful working within tight deadlines and a fast-paced environment.
- Strengthened communication skills through regular interactions with others.
- Organized and detail-oriented with a strong work ethic.
- Adaptable and proficient in learning new concepts quickly and efficiently.
- Used critical thinking to break down problems, evaluate solutions and make decisions.
- Paid attention to detail while completing assignments.
- Worked flexible hours across night, weekend and holiday shifts.
- Developed and maintained courteous and effective working relationships.
- Identified issues, analyzed information and provided solutions to problems.
- Participated in team projects, demonstrating an ability to work collaboratively and effectively.
- Evaluated and investigated over 519 auto claims in 2017 and decided whether insurer should pay claim
Medical Claims Adjuster
Dr EP Cooper
04.1994 - 02.2018
- Maintained knowledge of benefits claim processing, claims principles, medical terminology, and procedures and HIPAA regulations.
- Verified patient insurance coverage and benefits for medical claims.
- Managed large volume of medical claims on daily basis.
- Researched and resolved complex medical claims issues to support timely processing.
- Paid or denied medical claims based upon established claims processing criteria.
- Evaluated medical claims for accuracy and completeness and researched missing data.
- Monitored and updated claims status in claims processing system.
- Identified and resolved discrepancies between patient information and claims data.
- Used administrative guidelines as resource or to answer questions when processing medical claims.
- Assessed medical claims for compliance with regulations and corrected discrepancies.
- Followed up on denied claims to verify timely patient payment and resolution.
- Responded to correspondence from insurance companies.
- Processed insurance payments and maintained accurate documentation of payments.
- Reviewed provider coding information to report services and verify correctness.
- Generated reports on medical claims processing activities and results.
- 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.
- Read over insurance policies to ascertain levels of coverage and determine whether claims would receive approvals or denials.
- Conducted day-to-day administrative tasks to maintain information files and process paperwork.
- Identified insurance coverage limitations with thorough examinations of claims documentation and related records.
- Researched claims and incident information to deliver solutions and resolve problems.
- Reviewed police reports, medical treatment records, and physical property damage to determine extent of liability.
- Conducted comprehensive interviews of witnesses and claimants to gather facts and information.
- Reviewed and analyzed suspicious and potentially fraudulent insurance claims.
- Analyzed information gathered by investigation and report findings and recommendations.
- Resolved complex, severe exposure claims using high service oriented file handling.
- Investigated and assessed damage to property and reviewed property damage estimates.
- Reviewed new files to determine current status of injury claim and to develop plan of action.
- Analyzed information gathered by investigation and reported findings and recommendations.
- Evaluated original investigation reports and documents to resolve secondary concerns.
- Determined liability outlined in coverage and assessed documentation such from police and healthcare providers to understand damages incurred.
- Maintained contact with claimants and attorneys to determine treatment status.
- Followed up with insured individuals regarding premium and deductibles payments.
- Clarified coverage of losses to policyholders and provided assistance in itemizing damages and finding alternative living arrangements.
- Identified suspicious losses and contacted manager for investigative assistance.
- Reviewed questionable claims by conducting agent and claimant interviews to correct omissions and errors.
- Directed claims negotiations within allowable limit of $[Amount] and supported successful litigations for advanced issues.
- Assisted homeowners by coordinating vendor services, emergency repair, cleaning and contractors.
- Visited customer locations to evaluate damage and provided cost estimates for remediation.
- Worked with private investigators and attorneys on preparation of evidence, witness statements and other documentation in preparation for trial.
- Interviewed agents and claimants to correct errors or omissions and investigate questionable claims.
- Collected evidence to support contested claims in court.
- Followed up on potentially fraudulent claims initiated by claims representatives.
- Maintained suspicious claims database and prepared reports for supervisors.
- Directed and coordinated various investigations conducted by field investigation team.
- Synthesized data into comprehensive quarterly written reports for management.
- Established productive working relationships with public officials and law enforcement officers.
- Testified on behalf of agency as part of criminal and civic proceedings.
- Directed claims negotiations within allowable limit and supported successful litigations for advanced issues
Education
WGU -
MedicalAcademy
Skills
- Marketing
- Project Management
- Budget Planning
- Social Media
- Planning
- Communication
- Received 12 Employee Awards for customer service excellence
- Leadership
- Local Suicide Chapter Vice president for the midsouth area
- Policy Interpretation
- Multi-Line Phone Systems
- Insurance Policy Coverage Knowledge
- Settlement Determinations
- Claims Investigations
- Damage Mitigation
- Financial Accounting
- Fraud Detection Knowledge
- Claim Handling
- Claims Assessments
- Liability Determinations
- Medical Records Management
- Risk Assessment
- Court Proceedings
- Medical Terminology
- Monitoring Accounts
- Internal Fraud
- Auto Mechanics
- Claims Process Explanation
- Marketing
- Marketing
Timeline
Auto Claims Adjuster
AAS
08.2019 - 08.2023
Medical Claims Adjuster
Dr EP Cooper
04.1994 - 02.2018
WGU -
MedicalAcademy
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