CYNTHIA HAINLEY ERNST
Northfield,New Jersey
Summary
Interact professionally with all levels of staff and maintain the highest level of confidentiality; known for tact and diplomacy in handling sensitive issues. Proficiency in reading, assessing, and understanding insurance policies, claims documents, and patient medical records, while embracing teamwork to drive cohesiveness in routine operations. Possess advanced computer skills in Microsoft Word and Excel.
Professional with strong background in claims management, prepared to make significant impact. Skilled in assessing and processing claims accurately, resolving complex issues, and ensuring customer satisfaction. Effective team collaborator with focus on achieving results and adapting to changing needs. Known for analytical thinking, communication skills, and attention to detail.
Seasoned insurance professional with proven track record of effectively managing claims from initiation to resolution. Highly skilled in assessing coverage, coordinating with clients, and ensuring compliance with industry standards. Valued for strong team collaboration and adaptability in dynamic environments.
Organized and dependable candidate successful at managing multiple priorities with a positive attitude. Willingness to take on added responsibilities to meet team goals.
Overview
39
39
years of professional experience
1
1
Certification
Work History
Claim Representative
ARC Claims Management
04.2021 - 11.2025
- Remote
- Provide quality service to policyholders with ongoing communication of claims process and issues. Interact effectively with police, claimants, witnesses, and other relevant parties to estimate claim settlement, denial, or review. Investigation. Document claim file activities in an accurate and timely manner. Resolve claim issues promptly and follow-up on outstanding issues. Answer inquiries in reference to claims and resolve customer complaints. Responsible for researching claims to decide the validity of the claim and settle claim accordingly. Demonstrated Quality, Decision Making and Judgement Communication with all parties.
- Delivered quality customer service by providing limited instruction on proceeding with claims as well as made referrals to auto repair facilities or local contractors.
- Worked productively in fast-moving work environment to process large volumes of claims.
- Negotiated favorable settlements with claimants, resulting in cost savings for the company.
- Evaluated and processed insurance claims to determine eligibility and validity.
- Communicated efficiently with clients to gather necessary information for claims resolution.
Patient Service Representative
Shore Medical Center
02.2020 - 03.2021
- Greeting, assisting patients and visitors. Processing referrals and pre-certifications. Call patients daily to confirm the next day's appointments and prepare charts. Verify patient's insurance and obtain necessary referrals and pre-certifications prior to the date of service. Performed outbound calls and answered inbound calls. Registered and scheduled new and established patient appointments. Complete check-out assuring patient plans, orders, medications, and follow-up appointments are processed prior to the patient leaving the office. Handling collection of patient copayments.
- Temporarily worked from home for 6 weeks.
- Performed all clerical duties assigned during shift.
- Comply with HIPAA rules and regulations regarding the protection of the patient privacy.
- Assist with any additional duties as needed or as directed by your manager.
Radiologist Assistant
Atlantic Medical Imaging
02.2004 - 11.2019
- Gather, organize, and document patient clinical information, such as preliminary reading slips, results of physical examination, progress notes, and health history. Arrange and confirm patient diagnostic appointments, surgeries, or medical consultations in a timely manner to ensure a high satisfaction rate. Administer departmental teaching files and support Radiologists with daily tasks.
- Commended by top-management and patients for executing day-to-day jobs with maximum efficiency.
- Conducted training and coaching sessions for new employees regarding Radiologist Assistant position.
- Delivered excellent performance and championed significant projects under strict deadlines.
- Enhanced radiologist efficiency through the timely completion of preliminary reports and documentation.
Personal Assistant to the CEO
Atlantic Medical Imaging
09.2003 - 02.2004
- Screened incoming and outbound calls, organized travel arrangements, developed reports, and compiled important business documents. Addressed patient queries and deliver support, while registered new patients, updated records, and completed insurance verifications.
- Interfaced with patients and visitors to greet upon arrival to the office to establish a positive environment.
- Coordinated medical records requests, maintaining confidentiality and compliance with regulations.
- Implemented process improvements for handling patient inquiries, enhancing service quality.
Claims Specialist
State Farm Insurance Company
01.1995 - 07.2003
- Acquired essential information by interviewing claimants, doctors, medical specialists, or employers. Managed high service-oriented files and resolved intricate, severe exposure claims. Examined the validity of claims and ensured compliance with company policies and procedures. Maintained an accurate database by inputting claim payments, reserves, and new claims into a computer system. Interfaced with legal counsel on claims requiring litigation to ensure adherence to all legislative terms.
- Facilitated in minimizing loss ratio and disposal of cases by inspecting and settling claims through technical knowledge and human relations skills.
- Reviewed documentation for accuracy and completeness, enhancing overall claim processing efficiency.
- Trained new team members on claims procedures and software systems, fostering knowledge sharing.
- Developed strong working relationships with external partners such as adjusters, legal counsel, and medical professionals to facilitate efficient claim resolution processes.
Claim Representative
Hanover Insurance Company
09.1986 - 10.1994
- Studied medical treatment records, physical property damage, police reports, and medical bills to ensure the extent of liability. Conferred with police, claimants, witness, and other relevant parties to estimate claim settlement, denial, or review. Determined insurance coverage of claims by analyzing insurance policies, claims forms, and other records. Communicated with insurers or relevant parties to gather and compile missing data, and attached information to claim files.
- Delivered quality customer service by providing limited instruction on proceeding with claims as well as made referrals to auto repair facilities or local contractors.
Education
Bachelor of Science - Health and Physical Education
Lock Haven University
Lock Haven, PA05.1986
Skills
- Proficient in Microsoft Office
- Customer engagement
- Collaborative teamwork
- Insurance coverage analysis
- Claims management
- Regulatory compliance expertise
- Problem analysis and resolution
- Employee training and mentorship
- Insurance eligibility assessment
- Document organization
- Thorough claims analysis
- Claims analysis
- Data interpretation
- Strategic decision-making
- Effective time management
- Policy coverage evaluation
- Proficient in settlement negotiation
- Settlement analysis
- Skilled in resolving conflicts
Certification
- Texas- All Lines DHS License
License No: 2818227 Issue Date: 03/28/2022
Expiration Date: 05/31/2026
Timeline
Claim Representative
ARC Claims Management
04.2021 - 11.2025
Patient Service Representative
Shore Medical Center
02.2020 - 03.2021
Radiologist Assistant
Atlantic Medical Imaging
02.2004 - 11.2019
Personal Assistant to the CEO
Atlantic Medical Imaging
09.2003 - 02.2004
Claims Specialist
State Farm Insurance Company
01.1995 - 07.2003
Claim Representative
Hanover Insurance Company
09.1986 - 10.1994
Bachelor of Science - Health and Physical Education
Lock Haven University