Hi, I’m
ASHLEY OREDIA
Grand Prairie,TX
Summary
Insurance Adjuster skilled in investigating and analyzing liability concerning personal, casualty or property loss. Proven history of leveraging excellent negotiation skills to facilitate settlements. Excellent communication skills demonstrated through 4 years of experience interviewing specialists, witnesses and claimants to compile information. Business-minded with exemplary skills in customer service, time management and service coordination. Bringing related experience combined with superior mathematical abilities. Pursuing similar position with expanding insurance company. Licensed Adjuster with solid abilities in developing objectives and strategies to settle first party medical claims. Excellent skills compiling, coding, categorizing and auditing information to process claims.
Overview
9
years of professional experience
1
Certification
Work History
STATE FARM INSURANCE INCRichardson, TX
Bodily Injury Claims Specialist
11.2021 - 10.2022
Job overview
- Conducted full claim investigations and reported updates and legal actions.
- Reviewed new files to determine current status of injury claim and to develop plan of action.
- Addressed average of 200 customer inquiries and complaints each week.
- Checked documentation for accuracy and validity on updated systems.
- Maintained strong knowledge of basic medical terminology to better understand services and procedures.
- Referred claims to subrogation or special investigation unit as appropriate
- Maintained knowledge of medical billing and coding
- Prepared and participated in litigation, mediation, and arbitration to settle claims
- Processed claim payments with a personal financial authority of 10,000 and more with management approval
- Assured timely verification of insurance benefits prior to patient procedures or appointments.
- Posted payments to accounts and maintained records.
- Maintained confidentiality of patient finances, records and health statuses.
- Acted as PIP/MPC expert, answering internal and external questions and inquiries.
- Made contact with insurance carriers to discuss policies and individual patient benefits.
- Reviewed police reports, medical treatment records and physical property damage to determine extent of liability.
- Negotiated PIP/MPC settlement agreements to resolve disputes.
- Identified insurance coverage limitations with thorough examinations of claims documentation and related records.
- Resolved complex, severe exposure claims using high service oriented file handling.
- Reviewed and analyzed suspicious and potentially fraudulent insurance claims.
- Maintained contact with claimants and attorneys to determine treatment status.
- Directed claims negotiations within allowable limit of $10,000 and supported successful litigations for advanced issues. And processed additional limits with management authority limits approved.
- Investigated legal issues pertaining to first party auto medical claims.
- Modeled exceptional customer service skills and appropriate diagnostic sales techniques to team members.
- Carried out administrative tasks by communicating with clients, distributing mail and scanning documents.
- Verified client information by analyzing existing evidence on file.
- Generated, posted and attached information to claim files.
GEICORichardson, TX
Auto Claims Adjuster
02.2018 - 06.2021
Job overview
- Taking and processing auto claims for up to 4 vehicles with 0-100% liability
- Negotiated with claimants to settle claims.
- Examined photographs and surveillance and any other documents relating to claims.
- Issued payouts to claimants.
- Documented all findings in concise reports.
- Enhanced customer satisfaction by delivering honest advice to policyholders in regards to repair work and body shop processes.
- Documented vehicle damage and submitted photographs and in-depth reports to claims department for effective processing.
- Identified suspicious claims, escalating issues to special investigation unit for further investigation and analysis.
- Carried and managed consistently heavy project workload through exemplary organizational, time management and collaboration talents.
- Coordinated with local body shops to assign repair jobs and obtained rental vehicles for customers for duration of restoration process.
- Processed 40 invoices each day and mailed documentation to clients.
- Quickly learned new skills and applied them to daily tasks, improving efficiency and productivity.
- Carried out day-day-day duties accurately and efficiently.
- Performed duties in accordance with applicable standards, policies and regulatory guidelines to promote safe working environment.
- Worked flexible hours; night, weekend, and holiday shifts.
- Demonstrated respect, friendliness and willingness to help wherever needed.
- Investigated vehicle damage inflicted resulting from emergency situations and natural disasters.
GOLDEN RECOGNITION INCIrving, TX
Executive Administrative Assistant
08.2014 - 12.2018
Job overview
- Responded to emails and other correspondence to facilitate communication and enhance business processes.
- Organized and updated schedules for executives.
- Used software to coordinate meetings, appointments and tasks senior executives.
- Handled scheduling for executive's calendar and prepared meeting agenda and materials.
- Produced accurate office files, updated spreadsheets and crafted presentations to support executives and boost team productivity.
- Scheduled appointments and handled calenders for senior leadership.
- Prepared presentations, materials and documentation for use executives in meetings and engagements.
- Seamlessly interacted with colleagues to plan and complete special projects.
- Coordinated and booked airfare, hotel and ground transportation and prepared itinerary to facilitate successful trips.
- Implemented updated policies and practices for organization and monitored effect.
- Wrote and enforced administrative procedure plans to reduce errors and prevent process delays.
- Investigated topics and produced concise summaries use.
- Organized and coordinated conferences and monthly meetings.
- Created expense reports, budgets and filing systems for management team.
- Developed and updated spreadsheets and databases to track, analyze and report on performance and sales data.
- Processed travel expenses and reimbursements for executive team and senior management group.
- Trained junior office staff in correct procedures and reporting requirements.
- Worked collaboratively with auditors throughout reviews, offering assistance and clerical support.
- Transcribed minutes of meetings and executed meetings and events for company to support sales, business development and senior management teams.
- Developed and maintained automated alert system for upcoming deadlines on incoming requests and events.
- Screened calls and emails and initiated actions to respond or direct messages for managers.
- Prepared documents, reports and presentations for executives and board members using advanced software proficiencies.
Education
Ben Davis High SchoolIndianapolis, IN
Academic Honors Diploma
06.2014
University Overview
- Member of National Honor Society
UNIVERSITY OF TEXAS ARLINGTON Arlington,TX
BACHELOR OF SCIENCE from Information Technology
06.2020
Skills
- High-Exposure Claims
- Settlement Determinations
- Service Quality
- Liability Determinations
- Insurance Claim Forms Review
- Legal Processes
- Damage Mitigation
- Conflict Resolution Techniques
- Diagnostic Codes
- Complex Coverage Issues
- Billing Software
- Customer Relationship Management
- Payment and Investigation Escalations
- Work Organizing and Prioritizing
- Workers Compensation
- Staff Support
- Operational Efficiency
- Information Updates
- Insurance Policy Coverage Knowledge
- Claim Validity Determination
- Fraud Detection
- Coverage Determination
- Accident Investigations
- Claim Amount Calculations
Affiliations
National Honor Society Member
Leader in YLIA (YOUTH LEADERS IN ACTION) Teen Advocacy Group
Certification
- Licensed General All-Lines Adjuster - 2018-Current
Timeline
Bodily Injury Claims Specialist
STATE FARM INSURANCE INC
11.2021 - 10.2022
Auto Claims Adjuster
GEICO
02.2018 - 06.2021
Executive Administrative Assistant
GOLDEN RECOGNITION INC
08.2014 - 12.2018
Ben Davis High School
Academic Honors Diploma
UNIVERSITY OF TEXAS ARLINGTON
BACHELOR OF SCIENCE from Information Technology
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