Summary
Overview
Work History
Education
Skills
Certification
Timeline
Generic

Candace Jones

Auburndale

Summary

Dynamic Claims Manager with extensive experience at Summit, excelling in claims analysis and team management. Proven track record in enhancing customer satisfaction through effective resolution of escalated claims issues and implementing quality assurance measures. Skilled in training personnel and optimizing operational efficiency, driving continuous improvement in claims handling processes.

Overview

20
20
years of professional experience
1
1
Certification

Work History

Claims Manager

Summit
04.2011 - Current
  • Manage part of the medical reimbursement team to include coaching, feedback, performance evaluations
  • Managed escalated claims issues, providing resolutions to enhance customer satisfaction rates.
  • Developed training materials aimed at improving team knowledge of industry regulations and compliance requirements.
  • Implemented quality assurance measures, monitoring staff performance and providing constructive feedback for continuous improvement efforts.
  • Analyze medical bills to ensure compliance with company policies and regulatory standards.
  • Coordinated communication between external customers and internal teams to expedite the medical bill process.
  • Reviewed documentation for accuracy, identifying discrepancies to prevent delays in correct payment.
  • Implemented workflow improvements that enhanced operational efficiency in claims handling.

Claims Adjuster

Summit
02.2006 - 04.2011
  • Evaluated claims to determine validity and appropriate coverage under policy terms.
  • Conducted thorough investigations of claims beginning at intake of first notice of injury.
  • Liaised with legal teams to resolve disputes related to claims outcomes,
  • Negotiated favorable settlements to minimize financial risk for the company.
  • Examined claims forms and other records to determine compensability and benefits due
  • Maintained compliance with state regulatory requirements through meticulous documentation and adherence to company policies.

Claims Assistant

Summit
05.2005 - 02.2006
  • Collaborated with adjusters to gather documentation and expedite claim resolution timelines.
  • Prepared files, letters and notices.
  • Scheduled medical appointments
  • Carried out administrative tasks by communicating with customers, distributing mail, and scanning documents.

Education

Lake Region High School
Eagle Lake

Skills

  • Claims analysis
  • Claims investigation and research
  • Procedure implementation
  • Planning and organization
  • Team motivation
  • Team management
  • Quality assurance
  • Performance monitoring
  • Personnel training

Certification

Accredited Claims Associate

Board Certified Claims Adjuster

Timeline

Claims Manager

Summit
04.2011 - Current

Claims Adjuster

Summit
02.2006 - 04.2011

Claims Assistant

Summit
05.2005 - 02.2006

Lake Region High School

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