CHRISTINE DECKER
Mahwah,NJ
Summary
Well-versed in handling claims with a consistent approach. Knowledgeable about determining coverage, completing documentation and uncovering fraudulent claims. Forward-thinking and resourceful with strong communication and organizational abilities.
Overview
21
21
years of professional experience
Work History
Senior PIP Claims Representative
NJM Insurance Group
03.2003 - Current
- Handle all areas of Personal and Commercial claim files, including investigation, pre-certification, and appeals
- Interview claimants; explain policy terms, claims process, and record accident details
- Utilize LexisNexis to search for registered vehicles or active auto policies
- Analyze claim circumstances to determine coverage eligibility or referral to SIU
- Evaluate severity of claims to accurately forecast and allocate reserves
- Review medical records to substantiate causal relationship between accident and reported injuries
- Analyze medical records and bills for fraud indicators
- Liaise with attorneys and physicians to provide necessary documents while maintaining patient confidentiality
- Document claims progress
- Monitor, organize, and update files periodically
- Appropriately determine when independent medical exams are necessary to evaluate claimant’s status and future treatment options
- Train new team members
- Serve on Business Process Improvement team since its inception to assess current business processes/workflows and determine solutions to ensure better efficiency and productivity
- Present progress of BPI initiative at quarterly meetings
- Maintain a 1:1 ratio of claims by consistently closing inactive files throughout the month
Education
AIC -
Insurance Institute of America
2007
Bachelor of Arts - Psychology, Communications
Arizona State University
Tempe, AZ2002
Skills
- Guidewire ClaimCenter
- AgilePoint
- Inspire document generation
- OnBase Document Management
- Documentation Research
- Policy Knowledge
- Claims Evaluations
- Prior Authorization Processing
- Coverage Determination
- Workflow Processes
- Insurance Policy Coverage Knowledge
Accomplishments
- Collaborated with Business Process Improvement team in the development of NJM's official PIP Payment ledger.
- Tested company's new paperless claims system to ensure accuracy and efficiency. Met with senior management to review system and offer insights for the development team.
Timeline
Senior PIP Claims Representative
NJM Insurance Group
03.2003 - Current
AIC -
Insurance Institute of America
Bachelor of Arts - Psychology, Communications
Arizona State University
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