Summary
Overview
Work History
Education
Skills
Education
Contact
Timeline
Angelia  Moore

Angelia Moore

Memphis,TN

Summary

Qualified Manager versed in investigating claims, verifying information and managing settlements. Friendly and upbeat team player with organized and disciplined approach. Offering 26 years of insurance and claim experience. To seek and maintain full-time position that offers professional challenges utilizing interpersonal skills, excellent time management and problem-solving skills. Experienced in Medicare claims, workers compensation and medical claims.

Overview

16
16
years of professional experience

Work History

Senior Claims Examiner

Douglas LittleField Shield Insurance LLC
03.2008 - 12.2023

- Worked Auto claims processing from origination to completion.- Negotiated settlements with key decision makers in a timely manor.- Set up Auto rentals, Tows, and assisted Insured to find repair shops and manage repair times.- Used State Farm guidelines and state requirements to comply with state and federal laws.- Followed up with Insureds to ensure claim satisfaction.

  • Interviewed policyholders to verify information and obtain additional details.
  • Followed up with customers on unresolved issues.
  • Worked productively in fast-moving work environment to process large volumes of claims.
  • Examined reports, accounts, and evidence to determine integrity and accuracy of information.
  • Investigated accidents or incidents to determine cause and extent of damages.
  • Collaborated with internal departments and external vendors to achieve fast resolution of claims.
  • Modified, updated and processed existing policies.
  • Posted payments to accounts and maintained records.
  • Calculated adjustments, premiums and refunds.
  • Processed and recorded new policies and claims.
  • Maintained strong knowledge of basic medical terminology to better understand services and procedures.
  • Made contact with insurance carriers to discuss policies and individual patient benefits.
  • Notified insurance agents and accounting departments of policy cancellations and changes.
  • Verified client information by analyzing existing evidence on file.
  • Assured timely verification of insurance benefits prior to patient procedures or appointments.
  • Researched claims and incident information to deliver solutions and resolve problems.
  • Examined photographs and statements.
  • Investigated properties to determine extent of damage and estimate repair costs.
  • Consulted police and hospital records when needed.
  • Handled complaints and grievances using negotiating and problem-solving skills.
  • Directed claims negotiations within allowable limit of $350000 and supported successful litigations for advanced issues

Claims Representative Desk Adjuster

AAS
08.2018 - 08.2023

-Provide strong customer service to policyholders and vendors in multiple states - Review claims history and make coverage decisions based upon the policy and appropriate regulations - Evaluate supplement requests for accuracy and appropriateness and issue payments when needed, Worked with Property Loss up to 80k, In a Stewardship capacity.

  • Negotiated claim settlements with claimants and attorneys to resolve claims efficiently and fairly.
  • Collaborated with internal departments and external vendors to achieve fast resolution of claims.
  • Made contact with insurance carriers to discuss policies and individual patient benefits.
  • Maintained confidentiality of patient finances, records, and health statuses.
  • Carried out administrative tasks by communicating with clients, distributing mail, and scanning documents.
  • Evaluated damages and handled claim negotiations with insureds, claimants, attorneys and public adjusters.
  • Reviewed police reports, medical treatment records, and physical property damage to determine extent of liability.
  • Mitigated risks and increased profitability with well-developed strategies for reducing future claims and costs.
  • Negotiated with policyholders and claimants to reach mutually satisfactory resolutions.
  • Followed up with customers on unresolved issues.
  • Examined reports, accounts, and evidence to determine integrity and accuracy of information.
  • Worked productively in fast-moving work environment to process large volumes of claims.
  • Interviewed policyholders to verify information and obtain additional details.
  • Developed and implemented strategies to improve claim processes.
  • Maintained accurate and up-to-date records of claim information for future reference.
  • Interviewed policyholders to verify information and obtain additional details
  • Examined reports, accounts, and evidence to determine integrity and accuracy of information
  • Followed up with customers on unresolved issues
  • Worked productively in fast-moving work environment to process large volumes of claims

Education

Bachelor of Science - Accounting And Finance

Ultimate Medical Academy - Clearwater
12.2019

Skills

  • Proficient Microsoft Office (Word, Excel, Outlook, PowerPoint)
  • Worker Compensation in 12 states-AR, AL, NY, NJ, PA, GA, CO, CA NV, OH
  • Litigation
  • Reports claims to excess carrier; responds to requests of directions in a professional and timely manner
  • Communicates claim activity and processing with claimant and client; maintains professional client relationships
  • Ensures claim files are properly documented and claims coding is correct
    Refers cases as appropriate to supervisor and management
  • High Exposure Claims
  • 20 Years Experience
  • Manage litigation processes
  • Patient Care and Physical Therapy
  • Quality Assurance
  • Record Preparation
  • Coverage Assessments
  • Claims Processing
  • Insurance Policy Coverage Knowledge
  • Legal Proceedings Knowledge
  • Regulatory Compliance
  • Medical Coding
  • Project Management Expertise
  • Conflict Resolution Techniques
  • Stakeholder Relationship Management
  • Staff Training and Development
  • Performance Metrics Evaluation
  • Process Improvement Strategies
  • Policy Interpretation
  • Claims Investigation and Research
  • Performance Monitoring
  • Procedure Implementation
  • Insurance Policy Review
  • Call Center Transactions
  • Team Management
  • Disability Claims Process
  • Legal Compliance
  • Customer Expectations Management
  • Financial Acumen
  • Investigation Techniques
  • Claims Auditing
  • Litigation Management
  • AMS360
  • Magnify Predictive Targeting System
  • Automated Work Distributor (AWD)
  • Microsoft Office Suite
  • Verbal Communication
  • Client Interviewing
  • File and Record Management
  • Claims Evaluation
  • Front desk operations
  • Credit and cash payments
  • Customer assistance
  • Supply stocking
  • Time management
  • Safety and security procedures
  • Guest services
  • Account balancing
  • Patience and tolerance
  • Reservation handling
  • Resolving issues
  • Guest relations management
  • Greeting guests
  • Professionalism and discretion
  • Payment oversight
  • Mail and packages
  • Reservations
  • Transaction processing

Education

Clearwater, FL

Contact

Memphis, Tennessee 38122

Timeline

Claims Representative Desk Adjuster - AAS
08.2018 - 08.2023
Senior Claims Examiner - Douglas LittleField Shield Insurance LLC
03.2008 - 12.2023
Ultimate Medical Academy - Clearwater - Bachelor of Science, Accounting And Finance
Angelia Moore