Courtney Coronado
Lakeland,FL
Summary
Proven Licensed Claims Adjuster with a robust background of claims experience, adept in claims investigation and offering exceptional customer service. Streamlined claim processing efficiency by implementing strategic organizational solutions, significantly enhancing team performance. Skilled in medical terminology and property valuation, consistently ensuring compliance and accuracy in high-volume environments.
Overview
10
10
years of professional experience
Work History
Injury Adjuster
National General Insurance Company
05.2021 - 05.2024
- Processes Personal Injury Claims, Medical Payments, and wage loss claims for the state of FL
- Obtain medical bills and records; Adjust medical bills per company guidelines, issue wage loss claims up to specific policy limit’s, issue co-pay and prescriptions reimbursement request, and medically manage certain claims when necessary
- Prepare denial letters, write clear and concise diary notes, and make’s payments to insureds, attorneys, vendors, and subrogation companies.
- Processes provider disputes Medicare, Medicaid, and commercial health insurance companies.
- Works with attorneys and processes their Med Pay and PIP demands.
- Maintained strong relationships with policyholders, agents, and colleagues by consistently demonstrating professionalism, empathy, and effective communication skills.
- Ensured compliance with state regulations and company policies through diligent review of all claim-related materials.
- Assisted clients in understanding their insurance coverage by explaining complex terms and conditions clearly and concisely.
- Improved claim processing efficiency by conducting thorough investigations and promptly addressing discrepancies.
- Reviewed police reports, medical treatment records, and physical property damage.
- Contributed to team success by participating in regular training sessions, sharing best practices, and mentoring new adjusters.
- Examined claims forms and other records to determine insurance coverage.
Medical Payments Adjuster
Progressive
07.2019 - 04.2021
- Processes Medical Payments, and Personal Injury Protection (PIP) Claims for 34 states.
- Obtains recorded statements from injured parties; Update medical claims with injury and treatment information and effectively manage pending files in accordance with Claims Best Practices.
- Appropriately applies knowledge of multiple states statues, including the insurance code of ethics, rules, regulations, and guidelines.
- Obtains medical bills, and records; Adjusts medical bills per company guidelines, issue wage loss up to specific policy limits, issue co-pay and prescription reimbursement requests and medically managing claims when necessary.
- Prepare denial letters, Reservations of Rights, and writes clear and concise diary notes, sets and saves contacts, and makes payments to insureds, attorneys, vendors, and subrogation companies.
- Processes provider disputes, Medicare, Medicaid, and Commercial Health Insurance Subrogation & Lien requests.
Auto Claims Adjuster
GEICO
09.2016 - 04.2019
- Managers high volume of claims from beginning until end.
- Acted as a reliable point of contact for customers throughout the claims process, addressing their concerns with empathy and professionalism.
- Demonstrated expert knowledge of auto insurance policies and coverages, allowing for accurate assessment of damages and appropriate claim payouts.
- Documented all findings in concise reports.
- Established an effective system for tracking and monitoring claims from initial report to final resolution, ensuring timely updates were provided to all relevant parties.
- Interviewed all involved parties to determine coverage and liability decisions
- Specialized in RV claims
- Gathered and documented evidence to support court proceedings
- Used all available resources and tools to determine a liability decision.
- Collaborated with others to discuss new claim handling opportunities.
Insurance Payment Processor
Watson Clinic, LLC
08.2014 - 09.2016
- Managed high-volume payment processing tasks, consistently meeting deadlines without compromising accuracy or quality.
- Followed up with different medical carriers in reference to payments issued, or any denials sent.
- Monitored outstanding balances, following up on overdue payments to minimize loss or delay in revenue collection.
- Streamlined payment processing by implementing efficient systems and organizational strategies.
- Communicated with customers to review payments, and patient responsibility.
- Optimized payment processing department performance by establishing and monitoring key performance metrics, identifying areas for improvement, and implementing targeted solutions.
- Executed medical billing including submitting claims to insurance companies; Researching, and resolving denials, and explanation of benefits (EOB) rejections within the billing cycle timeframe.
Education
Business
Lake Gibson Senior High School
Lakeland, FL06.2010
Skills
- Licensed Claims Adjuster
- Excellent customer service
- Medical terminology
- Claims Investigation
- Technical knowledge
- Team building
- Excellent organization
- Property valuation
Timeline
Injury Adjuster
National General Insurance Company
05.2021 - 05.2024
Medical Payments Adjuster
Progressive
07.2019 - 04.2021
Auto Claims Adjuster
GEICO
09.2016 - 04.2019
Insurance Payment Processor
Watson Clinic, LLC
08.2014 - 09.2016
Business
Lake Gibson Senior High School
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