DAVID ALLEN
Wittmann,AZ
Summary
CLAIMS PROFESSIONAL: Detail-oriented and driven individual with experience managing Medical Billing Claims, Complex Homeowner Claims, Automotive Claims, and Liability claims. Accomplished, dedicated, and knowledgeable Claims Professional, credited with 12 years of vast career roles to include Senior Claim Specialist, Small Property Adjuster, Auto Claims Adjuster, and Insurance Specialist. Executes as a subject matter specialist regarding various claim's practices. Provides excellence, promoting, and cultivating in a team environment through leading support training, development and mentoring to staff members. Illustrates thought-leader qualities through creating new claim platforms which provides efficiency and productivity and implementation of time management programs. Offers strong collaborative communication skills with all members, partners, and clients within the organization.
Overview
9
9
years of professional experience
Work History
Owner Operator
Desert Treasure and Wholesale
Wittmann, AZ
06.2023 - Current
- Analyze and resolve customer concerns using fresh approaches and analytical strategies
- Manage vendor and supplier relationships to obtain favorable terms for materials and services.
- Develope strong customer relationships through effective communication and problem-solving abilities.
- Implement pricing strategies that optimally aligned competitiveness and profitability objectives.
- Oversee the overall functionality of the business on a daily basis by driving sales performance, maintaining optimal inventory levels and ensuring accurate accounting practices.
Medical Claims Associate
Roundstone Insurance
Akron, Ohio
11.2021 - 01.2023
- Researched discrepancies between provider-submitted documentation and payer requirements.
- Verified insurance coverage of medical claims to ensure accurate reimbursement.
- Documented all activities related to claim submission in an organized manner for audit purposes.
- Ensured compliance with HIPAA regulations pertaining to the secure storage and transmission of confidential patient information.
- Utilized various software applications, including word processing and spreadsheet programs, as required.
- Conducted detailed analysis of medical records to determine eligibility for services covered by insurance plans.
Senior Claim Specialist
Advanced Reimbursement Solutions
Scottsdale, AZ
08.2020 - 08.2021
- Provided ongoing assistance and support to ensure resolution of client billing inquiries
- Effectively communicated with operations and staff, ensuring confidentiality of patient records and health statuses
- Reviewed requests to ensure timely completion of projects
- Mentored and trained new hires in complex liability dispute resolution and policy analysis
- Delivered exceptional customer service through effective communication and active listening to address client concerns.
Inside Property Adjuster
Allstate Insurance
Chandler, Arizona
10.2017 - 07.2020
- Conducted comprehensive property investigations to assess and categorize damages for client claims
- Examined claims documentation and related records in detail, identifying insurance coverage limitations
- Investigated and assessed property damage, while reviewing property damage estimates.
- Conducted thorough assessments on claims forms and records to ascertain insurance coverage.
- Utilized strong analytical skills to assess policy language for determining coverage availability and identifying loss exclusions.
- Coordinated with engineers, surveyors, and appraisers from outside vendors.
- Negotiated settlements with claimants based on coverage limits and applicable laws.
Small Property Claims Adjuster
HOMESITE INSURANCE
Phoenix, AZ
05.2015 - 09.2017
- Evaluated claims forms and other documents to establish insurance coverage
- Examined claims associated with potential and suspected fraudulent activities, conducting in-depth investigations
- Acquired customer claim details to ensure the accurate preparation of claims and legal documentation.
- Answered customer questions regarding deductibles
- Evaluated insurance policies and assessed damages to determine coverage.
- Performed thorough inspections for insurance claims, resulting in prompt and fair settlements.
- Meticulously monitored the progress of outstanding claims to ensure prompt resolution.
- Documented all activities related to a claim such as conversations with claimants or insurance representatives.
- Adhered to company policies and procedures when handling claims.
- Communicated with customers via phone or email to update them on their claims status or answer questions they may have had.
Education
Technical Diploma - Medical Assisting
Pima Medical Institute
Certificate - Basic Corrections
Rio Salado College
Texas Property & Casualty License -
Rio Salado College
Skills
- Coverage assessments
- Documentation review
- Accident investigations
- Benefit explanation
- Building construction knowledge
- Customer service and support
- Claims file management processes
- Property claims
- Xactimate experience
- Liability Determination
- Team Leadership
- Asbestos claims
- Investigative abilities
- Policy Interpretation
- Insurance knowledge
- Critical Thinking
- Excellent Communication
- Analytical Skills
Timeline
Owner Operator
Desert Treasure and Wholesale
06.2023 - Current
Medical Claims Associate
Roundstone Insurance
11.2021 - 01.2023
Senior Claim Specialist
Advanced Reimbursement Solutions
08.2020 - 08.2021
Inside Property Adjuster
Allstate Insurance
10.2017 - 07.2020
Small Property Claims Adjuster
HOMESITE INSURANCE
05.2015 - 09.2017
Technical Diploma - Medical Assisting
Pima Medical Institute
Certificate - Basic Corrections
Rio Salado College
Texas Property & Casualty License -
Rio Salado College