Casandra Morris
Richfield Springs,NY
Summary
Adept at claims evaluation and negotiation, I excelled at NYCM Insurance by mastering regulatory compliance and enhancing customer service. Leveraging critical thinking and adaptability, I significantly improved claim resolution efficiency. My expertise in case management and problem-solving drove successful outcomes in complex cases, showcasing my ability to deliver results in a demanding environment.
Overview
17
17
years of professional experience
Work History
Casualty Examiner II
Nycm Insurance
Edmeston, NY
12.2021 - Current
- Researched complex issues related to specific cases involving multiple parties or unusual circumstances.
- Investigated claims to determined if claims were valid including but not limited coverage, fraud, and illegible parties.
- Interacted professionally with customers providing clear explanations for decisions made regarding their claims.
- Monitored progress throughout the life cycle of each claim ensuring timely resolution.
- Provided support and guidance to colleagues to maintain a collaborative work environment.
- Reviewed medical packets and other relevant documents to establish the value of claims.
- Collaborated with defense counsel to ensure claim was being handled timely and the best result was obtained.
- Negotiated the settlement of claims with plaintiff counsel and pro se claimants the use of mediation, arbitration and litigation.
- Presented claims in a roundtable forum to obtain additional authority for settlement.
- Drafted disclaimers, denial and delay letters for claims.
No-Fault Examiner II
NYCM Insurance
Edmeston, New York
06.2018 - 12.2021
- Evaluated eligibility for benefits based on analysis of case facts and application of applicable laws.
- Determined if claims were valid according to established rules and regulations.
- Resolved customer inquiries regarding claims status in a timely manner.
- Assisted with customer requests and answered questions to improve satisfaction.
Quality Assurance Specialist
Springbrook
Oneonta, New York
09.2013 - 06.2018
- Interviewed subjects, targets and witnesses for information verification and corroboration.
- Reviewed police reports, medical records, and other documents for evidence.
- Liaised with law enforcement agencies to investigate potential abuse.
- Trained staff on reporting regulations and corporate compliance.
- Audited departments within the agency for compliance of state and federal laws.
- Compiled investigative reports summarizing key facts and recommendations based on the outcome of the investigation.
PCA
Bassett Medical Center
Cooperstown, New York
03.2008 - 09.2013
- Answered questions from family members regarding patient's condition or care plan.
- Provided personal care assistance to elderly and disabled individuals in their homes, including bathing, dressing, grooming, transferring, toileting and feeding.
- Delivered outstanding patient care based on physical, psychological, educational and related criteria.
Education
Bachelor of Arts - Criminal Justice With A Minor in Sociology
Niagara University
Niagara Falls, NY01-2011
Skills
- Claims evaluation
- Regulatory compliance
- Negotiation strategies
- Case management
- Customer service
- Problem solving
- Time management
- Critical thinking
- Claims investigations
- Adaptability and flexibility
Timeline
Casualty Examiner II
Nycm Insurance
12.2021 - Current
No-Fault Examiner II
NYCM Insurance
06.2018 - 12.2021
Quality Assurance Specialist
Springbrook
09.2013 - 06.2018
PCA
Bassett Medical Center
03.2008 - 09.2013
Bachelor of Arts - Criminal Justice With A Minor in Sociology
Niagara University