Dasia Gipson
Forney,TX
Summary
Analytical Claims Specialist with extensive expertise in the insurance industry, specializing in risk analysis, claims processing, and customer service. Adept in investigating suspicious activities, gathering evidence, and delivering thorough reports to support case resolutions. Bringing forth the ability to properly investigate a situation and resolve claims quickly.
Overview
9
9
years of professional experience
Work History
Claims Specialist II
State Farm Insurance Co
02.2023 - Current
- Demonstrate expert knowledge of auto insurance policies including Personal Injury Protection and First Party Medical coverage, allowing for accurate assessment of damages and appropriate claim payouts
- Investigate and document claim circumstances, gather evidence, and validate coverage through systematic review of policy terms and conditions
- Evaluate wages, household services, attendant care, case management, and Survivor Benefit payments owed to policyholders, including requesting and reviewing documents and applying statutory regulations
- Review claims to resolve indicators of fraud and initiate payment or, if investigation determines the claim is without merit, resist payment of claims
Medical Claim Specialist
Molina Healthcare
04.2020 - 01.2022
- Guide policyholders through claim processes, provide timely updates, and resolve disputes while ensuring exceptional customer satisfaction
- Partner with legal teams, medical providers, and external stakeholders to facilitate comprehensive claim resolutions and maintain service excellence
- Achieved a 95% accuracy rate in claims assessment through detailed investigations
- Collaborate with external and internal medical professionals to properly investigate and manage files, with a strong understanding of healthcare and health insurance protocols and emphasis on detailed claim analysis
Claims Analyst
New York Life Insurance Co
08.2016 - 02.2020
- Manage and review life insurance claims, ensuring all necessary documentation (death certificate, beneficiary information, and medical records) was complete and accurate
- Conduct thorough investigations into suspicious or complex claims, verifying the cause of death, policyholder history, and identifying discrepancies or red flags
- Coordinate with medical professionals, funeral homes, and other institutions to validate claim details
- Determine claim payouts based on policy terms and investigation results
Education
Some College (No Degree) - Paralegal Studies
Eastfield College
Mesquite, TXSkills
- Verbal, interpersonal, and written communication
- Critical and analytical thinking
- Accountability
- Attention to detail
- Investigative skills
- Risk assessment
Timeline
Claims Specialist II
State Farm Insurance Co
02.2023 - Current
Medical Claim Specialist
Molina Healthcare
04.2020 - 01.2022
Claims Analyst
New York Life Insurance Co
08.2016 - 02.2020
Some College (No Degree) - Paralegal Studies
Eastfield College
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