Ciara Simmons

• Investigated complex residential and commercial property insurance claims, ensuring compliance with company policies and state insurance regulations to uphold integrity of claims process.

• Analyze documentation, policy language, inspection reports, and supporting evidence to determine claim eligibility and coverage.

• Evaluated claim files for accuracy and completeness, ensuring regulatory compliance and maintaining detailed electronic records to support efficient claim management.

• Communicate claim determinations and policy requirements to policyholders, contractors, and internal stakeholders.

• Resolve complex issues by collaborating with cross-functional teams to ensure timely claim resolution.

• Identified trends and discrepancies during claim investigations.

• Maintain confidentiality while managing multiple high-priority cases in a fast-paced environment.

• Conducted comprehensive investigations into child abuse and neglect allegations, interviewing children, families, educators, healthcare professionals, and law enforcement to gather critical information.

• Evaluated compliance with state child welfare policies and assessed family safety through home visits, risk assessments, and ongoing monitoring.

• Developed and monitored corrective service plans to enhance family safety and ensure adherence to court and agency requirements.

• Prepared detailed investigative reports, legal documentation, and case summaries for judicial review.

• Assisted families by providing education regarding available services, program requirements, and community resources.

• Coordinated non-emergency medical transportation services, ensuring compliance with Medicaid guidelines and contractual requirements to facilitate timely access for members.

• Reviewed eligibility requirements and verified documentation before authorizing transportation services.

• Assisted members, healthcare providers, and facilities by clearly explaining policies, procedures, and program requirements, enhancing understanding and service delivery.

• Maintained HIPAA compliance while managing confidential medical information.

• Consistently exceeded customer service expectations while meeting productivity and quality assurance standards.