Friendly insurance professional examines claims, negotiates and processes settlements and verifies insurance coverage. Attentive team player consistently treats clients fairly and equitably. Motivated to succeed in fast-paced and deadline-driven professional environment.
Overview
9
9
years of professional experience
Work History
Long Term Disability Claim Specialist
Metropolitan Life Insurance - MetLife
2021.11 - 2023.01
Provided timely, balanced and accurate claims reviews, documentation and recommended decisions in a time sensitive and fast-past environment and in accordance with state and department of insurance regulations
Communicated with a variety of constituents (claimants, doctors, nurses, employers, and attorneys) to gather information relevant to rendering decisions based on the provisions of the policy
Clarified and reconciled inconsistencies when gathering information during claim evaluations and collaborates with Fraud Waste and Abuse resources as needed and addresses/resolves escalated customer complaints in a timely and thorough manner
Compiled file documentation and correspondence requiring extensive policy and factual detail
Analyzed information to determine if additional information was needed to make a reasonable and logical claims determination based on information available.
Appeals Coordinator
Med-Scribe, Inc.
2021.01 - 2021.05
Facilitated the administration of insurance appeals after a denial
Analyzed and assessed facts that pertained to the case to make decisions in a timely manner
Communicated with policyholders and or insurance companies to acquire missing information for appeal consideration.
Claims Examiner
MedPro Group
2014.05 - 2020.08
Adjudicate claims based on the sold policy
Consistently meet or exceed processing goals
Manage agent and claimant phone calls
Work effectively with Team Lead & QA Auditor regarding claim questions
Request additional data necessary to process claim.
Assistant Manager - PMO at MetLife (Metropolitan Life Insurance Company), USAssistant Manager - PMO at MetLife (Metropolitan Life Insurance Company), US