April Williams
Kennesaw,GA
Summary
Thorough Claims Resolution Specialist skilled handling basic and complex claims with accuracy and efficiency. Good communication, organizational and problem-solving abilities. Examiner with 20 + years of experience. Strong command of conflict resolution and negotiation combined with excellent reporting and research skills. Thorough understanding of claims processing. Solid abilities in developing objectives and strategies to settle diverse claims. Excellent skills compiling, coding, categorizing and auditing information to process claims.
Overview
9
9
years of professional experience
Work History
Auto Claim Specialist
State Farm
Dunwoody, GA
03.2023 - Current
- Reviewing and analyzing injury claims to determine coverage, liability, and damages
- Conducting thorough investigations by gathering relevant information, interviewing involved parties, and reviewing supporting documentation
- Evaluating medical records, police reports, and other related documents to assess the extent of injuries and liability
- Negotiating settlements with claimants, ensuring fair compensation is provided within policy limits
- Documenting all claim activities, maintaining accurate records, and preparing reports as required
- Collaborating with internal teams, including legal, medical, and risk assessment, to ensure proper claim handling
- 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.
- Reviewed police reports, photographs and other documentation to gain complete understanding of accident.
- Built strong working relationships with insurance adjusters, attorneys, medical providers, and other stakeholders involved in the claims process.
Professional Billing Account Coordinator
Children's Healthcare of Atlanta
Atlanta, GA
04.2019 - 02.2023
- Entered data, generated reports, and produced tracking documents.
- Improved team productivity with regular communication and progress updates, fostering a collaborative work environment.
- Investigating, evaluating, negotiating, and settling claims.
- Ensured that special billing needs by payor are performed to prevent denial of claims and delay in payments.
- Prepared and submitted all final billed claims, secondary claims, rebills, and late charges on a daily basis maintaining a good status.
- Performed routine follow-up on unpaid insurance claims, taking appropriate action to resolve problems causing delays in reimbursements.
- Take appropriate actions to resolve all insurance, bad debts, and/or self-pay unpaid balance.
- Assist with training new employees, identifying areas for improving individual and team performance. Develop presentations and training materials.
- Handled high dollar claim activities including investigations, claim payments, and refunds.
AR Claims Follow-up
WellStreet (BEAUMONT)
Newnan, GA
10.2015 - 12.2018
- Reviewed medical documents thoroughly to accurately assess eligibility for disability benefits under various policies.
- Improved customer satisfaction ratings by providing timely and accurate information on claim status.
- Assisted policyholders in understanding their coverage options while compassionately handling emotionally charged situations surrounding loss events.
- Participated actively in ongoing professional development opportunities to stay current on industry trends and best practices within the field of Claims Administration.
- Managed a high volume of claims, prioritizing tasks based on urgency and importance.
- Resolved issues through active listening and open-ended questioning, escalating major problems to manager.
- Responsible for following up on denied claims, contacting medical providers, state, and commercial insurance.
- Resolve denied or unprocessed claim, submitted corrected claims, and process appeals.
- Successfully exceeding monthly metrics.
Education
MBA - Master of Business Administration
DeVry University
Villa Park, IL05.2026
Master of Science - Business Administration And Management
University of Phoenix
Tempe, AZ05.2018
Bachelor of Science - Business Administration
University of Phoenix
Tempe, AZ05.2015
Skills
- Claims Investigation
- Damage Assessment
- Policy Interpretation
- Automotive Repair
- Expert Negotiation
- Insurance regulations knowledge
- Billing
- Multi-line phone system
- Claims Handling
- Claims process explanation
- Teamwork and Collaboration
- Problem-Solving
- Time Management
- Attention to Detail
- Problem-solving abilities
- Multitasking Abilities
- Excellent Communication
- Organizational Skills
- Active Listening
- Effective Communication
- Adaptability and Flexibility
- Decision-Making
- Customer service expertise
- Task Prioritization
- Self Motivation
- Interpersonal Skills
- Analytical Thinking
- Goal Setting
- Professionalism
- Time management abilities
- Interpersonal Communication
- Adaptability
- Written Communication
- Proficient in Microsoft Software
- Documentation Management
- Problem-solving aptitude
- Professional Demeanor
Timeline
Auto Claim Specialist
State Farm
03.2023 - Current
Professional Billing Account Coordinator
Children's Healthcare of Atlanta
04.2019 - 02.2023
AR Claims Follow-up
WellStreet (BEAUMONT)
10.2015 - 12.2018
MBA - Master of Business Administration
DeVry University
Master of Science - Business Administration And Management
University of Phoenix
Bachelor of Science - Business Administration
University of Phoenix