Angelia Moore
Memphis,TN
Summary
Knowledgeable Workers Comp Adjuster with proven ability to handle complex claims and resolve disputes efficiently. Demonstrated success in negotiating settlements and enhancing client satisfaction. Effectively utilized analytical and decision-making skills to ensure accurate and fair adjustments.
Overview
41
41
years of professional experience
Work History
Workers Compensation Senior Adjuster
Advanced Business Solutions Group
01.1996 - Current
- Handled claims with efficiency and accuracy, leveraging a strong understanding of insurance regulations
- Streamlined the claims process and provided clear explanations to customers using Salesforce and other databases
- Assessed damages and risks
- Identified insurance coverage limitations with thorough examinations of claims documentation and related records
- Increased claim resolution efficiency by streamlining the adjustment process and implementing new procedures.
- Analyzed information gathered by investigation and reported findings and recommendations
- Maintained compliance with state regulations by staying up-to-date on industry changes and implementing necessary adjustments.
- Followed up on potentially fraudulent claims initiated by claims representatives
- Collaborated with other departments to improve overall claims handling processes and enhance interdepartmental communication.
- Reviewed police reports, medical treatment records, and physical property damage to determine extent of liability
- Managed administrative processes and principles, including accounting and data, in a medical setting
- Handled medical records with discretion and demonstrated a strong understanding of medical terminology
- Showcased excellent organizational and time-management skills, with the ability to multi-task and perform well under stress
- Communicated effectively with a strong customer service orientation
- Oversaw budget and billing payments, ordered supplies, supervised staff, maintained records, and ensured compliance with healthcare regulations and ethical standards
- Directed claims negotiations within allowable limit of 350000
- Developed rapport with customers through empathetic listening skills while providing prompt assistance during their time of need.
- Evaluated policy coverage for each claim, ensuring accurate interpretation of terms and conditions for proper settlement decisions.
- Improved customer satisfaction by efficiently handling and resolving complex auto insurance claims.
- Managed high-volume caseloads, maintaining organized records and timely communication with all parties involved.
- Enhanced team productivity by developing streamlined workflows for claim processing and task delegation.
- Achieved departmental goals for cycle times by consistently focusing on timely resolution of assigned claims.
- Maintained compliance with state regulations and company guidelines throughout the entire claims process.
- Handled subrogation efforts efficiently, recovering funds from liable third parties in a timely manner.
- Collaborated with other departments to ensure seamless coordination in handling multi-faceted claims scenarios.
- Provided exceptional customer service through proactive follow-up calls to keep customers informed about the status of their claims.
- Negotiated fair settlements for clients by thoroughly analyzing claim details and assessing appropriate payout amounts.
- Reduced fraud instances by conducting meticulous investigations and identifying suspicious claim patterns.
- Streamlined communication between internal teams and external partners such as repair shops, medical providers, attorneys, and others involved in the claims process.
- Documented all findings in concise reports.
- Negotiated with claimants to settle claims.
- Issued payouts to claimants.
- Examined photographs and surveillance and any other documents relating to claims.
Medical Claims Examiner
Dr. Edward P. Cooper
01.1984 - 02.1996
- Managed administrative processes and principles, including accounting and data, in a medical setting
- Handled medical records with discretion and demonstrated a strong understanding of medical terminology
- Showcased excellent organizational and time-management skills, with the ability to multi-task and perform well under stress
- Communicated effectively with a strong customer service orientation
- Oversaw budget and billing payments, ordered supplies, supervised staff, maintained records, and ensured compliance with healthcare regulations and ethical standards
Education
Medical Billing Coding -
01.2020
Finance - Financial Planning and Services
Skills
- Research
- Accounting
- Analytical
- Automotive Industry
- Billing
- Medical Billing And Coding
- Medical Records
- Decision Making
- Lawsuits
- Claim Processing
- Customer Service
- Communication
- Databases
- Ethics
- Grief Counseling
- Claims processing proficiency
- Investigation techniques
- Workers compensation
- HIPAA compliance
- Medical terminology
- Claims management
- Documentation review
- Fraud detection skills
- Litigation management
- Medical coding expertise
- Casualty claims
- Disability claims process
Timeline
Workers Compensation Senior Adjuster - Advanced Business Solutions Group
01.1996 - Current
Medical Claims Examiner - Dr. Edward P. Cooper
01.1984 - 02.1996
University of Florida - Finance, Financial Planning and Services
- Medical Billing Coding,
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