Brandy Gibson
Claims Adjuster
Wylie
Summary
Knowledgeable insurance professional with excellent customer service, research and document coordination skills. Bringing 16 years' experience working with Occupational accident and Worker's compensation claims.
Overview
19
19
years of professional experience
1
1
Certification
Work History
Claims Resolution Specialist
Sunbelt Partners
06.2024 - Current
- Contributed to team success by consistently meeting or exceeding individual performance metrics for claim resolution.
- Streamlined internal communication processes between departments for more efficient collaboration during claim investigations.
- Ensured compliance with industry regulations and company policies by staying up-to-date on relevant guidelines.
- Perform billing corrections and investigated, denials and appeals to obtain reimbursement from insurance companies.
- Worked denied claims for eligibility/coverage issues, authorization problems, Incomplete or incorrect information, coding errors, timely filing, and medically necessity. Contact members to obtain insurance information to pursue collections. I am proficient in both EPIC and MEDITECH programs.
Claims Supervisor
Method Insurance Services TPA
05.2015 - 06.2024
- Monitored team performance, enforcing compliance with occupational accident claims processes and procedures.
- Investigated, evaluated and adjusted multi-line claims in accordance with standards and laws.
- Optimized case management with establishment of best practices.
- Cultivated a productive relationships with policy holders, facilitating claims lifecycle.
- Ensured timely resolution of escalated claims by working closely with legal counsel and other stakeholders.
- Collaborated with legal counsel, finance teams, and policy holders to negotiate settlements that balanced risk mitigation with favorable financial terms.
All Line Claim Adjsuter
Process One TPA by Service Llyods
01.2007 - 05.2015
- Examined occupational accident claims forms and other records to determine insurance coverage.
- Reviewed police reports, medical treatment records, and first report of injury to determine extent of liability.
- Developed comprehensive reports outlining investigation findings, settlement recommendations, and supporting evidence for use in both internal reviews and external negotiations.
- Contributed to team success by participating in regular training sessions, sharing best practices, and mentoring new adjusters.
Education
Completed The Medical Assistant Program - Internal Medicine
Concorde Career College/ Methodist Dallas Medical Center
Dallas, TX 05.2001 -
Medical Billing And Coding Certification - Medical Billing And Coding
Stratford Career Institute
Dallas, TX 05.2001 -
Skills
Claims investigation
Empathy and patience
Customer service
Problem-solving
Billing management
Documentation skills
Fraud analysis
Certification
All lines claims adjuster licensed by Texas Department of Insurance. License is maintained and up to date.
Timeline
Claims Resolution Specialist
Sunbelt Partners
06.2024 - Current
Claims Supervisor
Method Insurance Services TPA
05.2015 - 06.2024
All lines claims adjuster licensed by Texas Department of Insurance. License is maintained and up to date.
01-2008
All Line Claim Adjsuter
Process One TPA by Service Llyods
01.2007 - 05.2015
Completed The Medical Assistant Program - Internal Medicine
Concorde Career College/ Methodist Dallas Medical Center
05.2001 -
Medical Billing And Coding Certification - Medical Billing And Coding
Stratford Career Institute
05.2001 -