DAI JUANA JOHNSON
Covington,GA
Summary
Claims adjuster and medical billing specialist with expertise in auto and property claims. Demonstrates strong negotiation skills, effective management of MedPay and PIP workflows, and a commitment to delivering empathetic customer service during high-pressure situations. Ready to apply extensive knowledge in a MedPay/PIP Claims Associate role.
Overview
8
8
years of professional experience
Work History
Catastrophe Field Property Adjuster
Allstate Insurance Company
04.2025 - 08.2025
- Conducted virtual investigations of property damage after catastrophic events, utilizing discretion and independence to ensure accurate assessments in high-pressure environments.
- Assessed coverage, documented loss details, and negotiated settlements within authority limits.
- Collaborated with contractors, engineers, and policyholders to assess structural damage and estimate repair costs, facilitating informed decision-making for timely claim resolutions.
- Provided compassionate support to clients facing emergencies.
Customer Service Billing Representative
Northside Hospital
08.2024 - 04.2025
- Resolved patient billing inquiries, explained insurance coverage, and coordinated with providers to verify benefits.
- Explained MedPay and PIP coverage details to patients involved in motor vehicle accidents, ensuring clarity on financial responsibilities.
- Verified benefits and coordinated with auto insurers, expediting claim processing and payment.
- Ensured HIPAA compliance while managing sensitive financial and medical data accurately.
- Assisted in documentation for injury-related claims, compiling medical records, itemized bills, and accident reports.
Total Loss Claims Specialist
State Farm Insurance Company
03.2023 - 07.2024
- Managed total loss claims from investigation to settlement, determining actual cash value and negotiating settlements with lienholders and salvage vendors to expedite resolution.
- Investigated advanced auto accident claims, determining coverage, liability, and damages with discretion and independence.
- Evaluated subrogation and fraud risks, implementing handling procedures to mitigate potential losses and ensure compliance.
- Communicated with customers during high-stress situations, providing clear support and guidance throughout the claims process to enhance customer satisfaction.
- Rotated through specialty roles including Total Loss and Extended Handler, enhancing crossfunctional expertise.
Medical Collector
University of Miami Hospital
07.2022 - 12.2022
- Managed collections for outstanding medical balances, negotiating payment plans and resolving insurance discrepancies to improve cash flow.
- Verified insurance coverage and coordinated with auto insurers and attorneys to resolve outstanding balances.
- Communicated with patients and insurers to expedite resolution of claims and account balances.
- Maintained detailed records, following up on delayed or disputed payments to facilitate timely collections.
- Specialized in collections for accident-related medical services billed under MedPay and PIP.
General Surgery Billing Coordinator
Baptist Health
03.2019 - 02.2021
- Coordinated billing workflows for accident-related surgical procedures, ensuring accurate documentation and timely submission to auto insurers and legal representatives.
- Interpreted MedPay and PIP coverage policies to verify benefits, resolve discrepancies, and support compliant reimbursement practices.
- Investigated medical records and accident details to confirm facts of loss and establish billing liability, mirroring claims investigation protocols.
- Collaborated with physicians, case managers, and insurance adjusters to assess injury severity and negotiate payment resolutions, enhancing claim outcomes.
- Identified subrogation opportunities and escalated cases with questionable liability or coverage disputes, facilitating resolution process.
- Applied advanced understanding of auto insurance billing regulations and organizational processes to streamline claim handling and improve recovery outcomes.
- Provided empathetic customer service to patients navigating post-accident care and insurance complexities, reinforcing National General's client-first approach.
Medical Payment Poster Representative
University of Miami Hospital
08.2017 - 03.2019
- Interpreted MedPay and PIP coverage details to validate reimbursements, resolve discrepancies, and support compliant billing practices.
- Posted payments from auto insurance carriers for accident-related medical services, ensuring accurate allocation and reconciliation across patient accounts.
- Investigated claim denials and underpayments by reviewing accident documentation, policy terms, and medical records-mirroring insurance adjuster workflows.
- Collaborated with legal representatives, adjusters, and billing teams to confirm facts of loss and clarify liability for injury-related charges.
- Identified patterns of delayed or inconsistent payments, escalating potential subrogation or fraud concerns for further investigation.
- Applied expertise in auto insurance billing regulations and organizational processes to streamline payment workflows, enhancing recovery outcomes.
- Provided responsive and empathetic service to patients and insurance contacts, facilitating resolution of complex post-accident billing issues.
Education
Bachelor of Science - Agricultural Economics
Fort Valley State University
Fort Valley, GA12-2028
Skills
- Property claims
- Auto Claims Investigation
- Claims investigation
- Damage assessment
- Claims handling
- Claims management
- Subrogation & Fraud Detection
- Claim Evidence Review
- Insurance Policy Interpretation
- Policy interpretation
- Insurance regulations
- Local Regulation Knowledge
- Regulatory Compliance
- Claims Software Proficiency
- Negotiation skills
- Team Coordination
Timeline
Catastrophe Field Property Adjuster
Allstate Insurance Company
04.2025 - 08.2025
Customer Service Billing Representative
Northside Hospital
08.2024 - 04.2025
Total Loss Claims Specialist
State Farm Insurance Company
03.2023 - 07.2024
Medical Collector
University of Miami Hospital
07.2022 - 12.2022
General Surgery Billing Coordinator
Baptist Health
03.2019 - 02.2021
Medical Payment Poster Representative
University of Miami Hospital
08.2017 - 03.2019
Bachelor of Science - Agricultural Economics
Fort Valley State University