ARNESHIA JAMES
Claims Adjuster
Mobile,AL
Summary
Service-oriented Claims Adjuster skilled at applying creative approaches to solving complex problems. Adept at developing profitable and quality-focused processes.
Overview
10
10
years of professional experience
5
5
years of post-secondary education
Work History
Claims Adjuster
CNC Catastrophe & National Claims
Mobile, AL
11.2022 - Current
- Interviewed agents and claimants to correct errors or omissions and investigate questionable claims.
- Examined claims forms and other records to determine insurance coverage.
- Identified insurance coverage limitations with thorough examinations of claims documentation and related records.
- Maintained claims data in Slate, Xactanalysis, ClaimSource
- Answered questions posed by insured and attorneys.
- Maintained invoices for Assignment of Benefits and Direction to Pay
- Investigated claims by reviewing policy contracts to determine claim coverage based on cause and facts of loss.
Claims Administrator
CNC Catastrophe & National Claims
Mobile, AL
09.2022 - 11.2022
- Optimized case management with establishment of best practices.
- Investigated, evaluated and adjusted multi-line claims in accordance with standards and laws.
- Improved operations by automating client correspondence, record tracking and data communications.
- Provided backup to desk adjuster to step in to assist with various claim tasks.
Patient Services Representative
Amerisource Bergen
Conshohocken, PA
01.2022 - 09.2022
- Effectively utilizes various means for collecting information using approved methods, which could include phone, fax, mail, and online methods
- Provides exceptional customer service to internal and external customers; resolves any customer requests in a timely and accurate manner; escalates complaints accordingly
- Ensures all program correspondence and communication (phone, fax, mail, etc) meets quality standards
- Works on problems of moderate scope where analysis of data requires a review of a variety of factors
- Exercises judgment within defined standard operating procedures to determine appropriate action
- Intakes and reports adverse events as directed
Interface Integration Analyst
CPSI
Mobile, AL
06.2017 - 09.2020
- Perform test and evaluation; assist production support team in resolving performance issues, defects, and database availability issues
- Test, manage and support, and implement HL7 clinical interfaces
- Provide functional, technical, and analytic expertise and advice to the IT Leadership and staff in matters relating to the design, development, integration, operation, management, and maintenance to ensure it business requirements are met
- Troubleshoot database related problems working with Application and Systems
- Administration; provide information to IT staff
- Configured and installed workstation, network operating systems and applications software on a wide range of configurable devices
- Design, implement and make recommendations based on studies relating to computing needs and performance including system back up
- Prepared and presented technical proposals for clients
- Maintained quality-focused performance benchmarks and schedules when directing project teams.
Sales Associate
Home Depot
Daphne, AL
02.2013 - 12.2018
- Retained product, service and company policy knowledge to serve as resource for both coworkers and customers
- Arranged new merchandise with signage and appealing displays to encourage customer sales and move overstock items
- Built trusting relationships with customers by making personal connections
- Collected payments and provided accurate change
- Used excellent verbal skills to engage customers in conversation and effectively determine needs and requirements
- Met and consistently exceeded revenue targets with proactive, customer-specific suggestions of accessories and related items
- Listened to customer needs to identify and recommend best products and services
- Reviewed files, recordings, and other documents to obtain information to respond to requests.
Education
Bachelor of Science - Allied Health, Health Informatics
University of South Alabama
Mobile, AL 08.2011 - 05.2016
Licenses & Certifications
- Texas All Lines #2839743
- Michigan: Fire & Other Hazards #1141585
- Florida #W922272
- Oklahoma 3002230461
- South Carolina 20332995
- State Farm: Auto, Property, Policy
- TWIA Claims Examiner
- TWIA Field Adjuster
- FEMA Certifications : IS-1000, IS-1001, IS-1002, IS-1009, IS-2900
Skills
Customer Service, Time Management, Insurance Authorizations, Data Entry & Maintenance, Team Building, Problem Solving, Policy Knowledge, Handle & Mitigate Errors and/or Complaints, Process Payments & Refunds, Efficient & Detail-Oriented, Typing 55+ WPM
Timeline
Claims Adjuster
CNC Catastrophe & National Claims
11.2022 - Current
Claims Administrator
CNC Catastrophe & National Claims
09.2022 - 11.2022
Patient Services Representative
Amerisource Bergen
01.2022 - 09.2022
Interface Integration Analyst
CPSI
06.2017 - 09.2020
Sales Associate
Home Depot
02.2013 - 12.2018
Bachelor of Science - Allied Health, Health Informatics
University of South Alabama
08.2011 - 05.2016
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