Corrie DaLuz
Bristol,RI
Summary
Summary of Qualifications
Astute ability to blend 20 years of dental and medical experience to the handling of workers compensation claims. Highly empathetic, adaptive, conscientious, resilient, and solution-focused. Excellent communication skills. Highly organized with superior customer service skills. Self-motivated and comfortable in a team environment Strong networking skills. Thrives in environments where I can build relationships.
Overview
21
21
years of professional experience
Work History
Claims Adjuster II
Markel
05.2022 - Current
- Examined claims forms and other records to determine insurance coverage.
- Directed and coordinated investigations coordinated with field investigation teams.
- Collected evidence to support contested claims in court.
- Maintained contact with claimants and attorneys to determine treatment status.
- Reviewed and analyzed suspicious and potentially fraudulent insurance claims.
- Worked with private investigators and attorneys on preparation of evidence, witness statements and other documentation in preparation for trial.
- Reviewed new files to determine current status of injury claim and developed plans of action.
- Resolved complex and severe exposure claim’s using high service oriented file handling skill set.
- Provided assistance to all levels of claims including large loss claims in relation to dental trauma injuries.
- Analyzed information gathered by investigation and report findings and recommendations.
- Delivered exceptional customer service to all parties by communicating important information clearly, timely, and compassionately listening to concerns.
- Reviewed police reports, medical records, and dental records to determined extent of liability.
- Negotiated large settlement agreements over $200k to resolves disputes and/or exposures.
- Proficient with MSA documents to settle claims over $25k
- Able to assist high level dental treatment coordination of care with providers and vendors.
- Assisted with mentorship to incoming adjusters.
Medical Only Claims Examiner
Markel Insurance Company
06.2021 - 05.2022
- Performing coverage investigations.
- Placing 24 hour contact calls with insureds, claimants, and providers.
- Performing ISO checks and inquiry’s.
- Knowledge of AOE/COE.
- Accurately processing complex dental treatment claims.
- Accurately processing medical only claims.
- Documented file notes clearly and concisely in Maverick.
- Reviewed policies to determine appropriate levels of coverage and assist with approval or denial decisions.
- Addressing subrogation referrals.
- Delivered exceptional customer service to claimants and insureds by communicating information accurately and timely.
- Delivered exceptional customer service to policyholders by communicating important information and patiently listening to issues.
- Documented information gathered in field and uploaded data to company database for efficient processing using Software.
- Paid or denied medical/dental claims based upon established claims processing criteria.
- Conducted day-to-day administrative tasks to maintain information files and process paperwork.
- Clarified coverage of losses to policyholders and provided assistance in itemizing damages and finding alternative living arrangements.
- Assessed medical claims for compliance with regulations and corrected discrepancies.
- Identified suspicious losses and contacted manager for investigative assistance.
Dental Hygienist
Dr. Kenneth Rawlinson
01.2020 - 06.2021
- Managed dental records and entered information using Eaglesoft to keep important patient information on file.
- Instructed patients on dental hygiene and oral care by demonstrating effective flossing and brushing techniques and recommending quality oral care products.
- Accurately collected and recorded patient medical and dental histories.
- Customized dental prophylactic treatment to meet individual patients' needs.
- Studied new and advanced dental hygiene methods and technology by completing continuing education coursework.
- Took dental images and X-rays to identify areas of concern and presented to dentists for review.
Dental Hygienist
East Bay Dental Dr. Thomas Enright D.M.D
12.2009 - 01.2019
- Instructed patients on dental hygiene and oral care by demonstrating effective flossing and brushing techniques and recommending quality oral care products.
- Accurately collected and recorded patient medical and dental histories.
- Customized dental prophylactic treatment to meet individual patients' needs.
- Took dental images and X-rays to identify areas of concern and presented to dentists for review.
Dental Hygienist
Dr. David Mastrostefano D.M.D.
06.2009 - 12.2009
- Instructed patients on dental hygiene and oral care by demonstrating effective flossing and brushing techniques and recommending quality oral care products.
- Applied cavity preventing agents, like fluoride and sealants, to protect patients' teeth from decay.
- Accurately collected and recorded patient medical and dental histories.
- Customized dental prophylactic treatment to meet individual patients' needs.
- Examined gums manually and visually to determine periodontal disease and screen for oral cancer.
- Took dental images and X-rays to identify areas of concern and presented to dentists for review.
- Customized prophylactic treatment to individual patients' needs.
Dental Hygiene Student
Community College of Rhode Island
01.2007 - 05.2009
- Took classroom training into field through supervised patient care experiences.
- Studied work of fully qualified hygienists to learn proper cleaning, examination and treatment techniques.
- Completed foundational courses in biology, communications and chemistry to prepare for dental hygiene studies.
- Learned how to communicate with patients to reduce anxiety and improve patient comfort.
- Managed dental equipment, including sanitizing between uses and replacing disposable covers.
- Customized dental prophylactic treatment to meet individual patients' needs.
Dental Assistant
Dr. Kenneth Rawlinson D.D.S. and Dr. Robin Rawlinson D.M.D
01.2004 - 01.2007
- Gathered and reviewed patient records, data and health history to share with dentists for quick and accurate patient assessments, diagnoses and treatment.
- Laid out dental instruments and equipment before procedures.
- Selected and prepared tools used for procedures by sanitizing and arranging.
- Stocked and prepared exam and treatment rooms by setting up required instruments, tools, supplies and equipment.
- Educated patients on treatment procedures and post-procedure home care.
- Took preliminary impressions of patient teeth to prepare for custom impressions and fabrication of permanent dental work.
- Followed dentists' directions for giving patients desensitizing agents to prepare for anesthetic administration.
- Instructed patients on postoperative care to protect dental work and promote healing.
- Produced opposing models, study casts and impressions to provide dentists with information on relationship between teeth, gums and dental arches.
- Created dental x-rays using traditional and digital methods to help dentists detect tooth decay, cavities and other issues needing to be treated.
- Passed instruments to dentist, gently sprayed water, suctioned fluids and mixed materials to support dentists during procedures.
Dental Assistant
Dr. Chad A. Borer D.D.S
01.2003 - 01.2004
- Laid out dental instruments and equipment before procedures.
- Gathered and reviewed patient records, data and health history to share with dentists for quick and accurate patient assessments, diagnoses and treatment.
- Produced opposing models, study casts and impressions to provide dentists with information on relationship between teeth, gums and dental arches.
- Stocked and prepared exam and treatment rooms by setting up required instruments, tools, supplies and equipment.
- Supported dentist with procedures.
Dental Assistant
Dr. Leslie A. Olton D.M.D. at We Care for Kids
01.2002 - 01.2003
- Assisted the doctors with four-handed dentistry.
- Assisted in front office duties including insurance claims and billing using Eaglesoft Dental Program.
- Use of Schick Digital X-ray Program.
- Assisted the doctors with pediatric, restorative, endodontic, crown and bridge, oral surgery, prostodontic, and cosmetic services.
Education
Associate of Applied Science - Applied Science Dental Hygiene
Community College Of Rhode Island
Lincoln, RI05.2009
Skills
- Dental Insurance code knowledge
- Medical Health background
- Holds worker’s compensation adjuster licensing in the states of CT DE FL GA KY MS NC NH RI SC VT WV
- Team player
- Flexible
- Strong work ethic
- Medical and Dental Terminology
- Microsoft Word
- Time Management
- Complex Problem-Solving
Accomplishments
- Maintained a consistent closing ratio of 100+ %.
Additional Information
- Awards , Recipient of the Community College of Rhode Island Class of 2009 Faculty Award for Clinical Excellence and Highest Clinical Grade Point Average
Timeline
Claims Adjuster II
Markel
05.2022 - Current
Medical Only Claims Examiner
Markel Insurance Company
06.2021 - 05.2022
Dental Hygienist
Dr. Kenneth Rawlinson
01.2020 - 06.2021
Dental Hygienist
East Bay Dental Dr. Thomas Enright D.M.D
12.2009 - 01.2019
Dental Hygienist
Dr. David Mastrostefano D.M.D.
06.2009 - 12.2009
Dental Hygiene Student
Community College of Rhode Island
01.2007 - 05.2009
Dental Assistant
Dr. Kenneth Rawlinson D.D.S. and Dr. Robin Rawlinson D.M.D
01.2004 - 01.2007
Dental Assistant
Dr. Chad A. Borer D.D.S
01.2003 - 01.2004
Dental Assistant
Dr. Leslie A. Olton D.M.D. at We Care for Kids
01.2002 - 01.2003
Associate of Applied Science - Applied Science Dental Hygiene
Community College Of Rhode Island
Similar Profiles
Amy KellyAmy Kelly
Senior Marketing Specialist at MarkelSenior Marketing Specialist at Markel
Ashton StuddardAshton Studdard
HR Analyst at MarkelHR Analyst at Markel
Julie SissonJulie Sisson
Underwriting Support Specialist at MarkelUnderwriting Support Specialist at Markel