Summary
Overview
Work History
Education
Skills
Accomplishments
Certification
Languages
References
Timeline
Generic

Dina Lewis

Denver,CO

Summary

Skilled Claim Examiner with background in investigating, evaluating, and settling insurance claims. Demonstrated strengths include thorough knowledge of insurance policies, strong analytical skills for determining the validity of claims, and adeptness at negotiating settlements. Previous roles have emphasized commitment to customer service and ability to handle multiple tasks simultaneously while maintaining accuracy and efficiency.

Overview

34
34
years of professional experience
1
1
Certification

Work History

Claim Examiner

Sedgwick
Greenwood Village , CO
09.2016 - Current
  • Attended continuing education courses to stay abreast of best practices in the field.
  • Maintained detailed records of all activities related to each claim file.
  • Communicated with claimants, attorneys and other parties involved in the process.
  • Collaborated with other departments on complex cases involving multiple parties.
  • Developed strategies for processing complex claims quickly and accurately.
  • Prepared various reports documenting findings and recommendations regarding claims resolution.
  • Advised customers on insurance coverage options available based on their needs.
  • Documented all information regarding claim status in the database system.
  • Researched legal precedents related to specific types of claims as needed.
  • Reviewed and evaluated customer claims to determine coverage eligibility.
  • Verified claimant identity and reviewed information for completeness.
  • Negotiated settlements with claimants as appropriate within established guidelines.
  • Ensured compliance with applicable state laws, regulations and standards of practice.
  • Assessed claim accuracy according to company policies and procedures.
  • Provided guidance and support to junior staff members on difficult cases.
  • Analyzed data from medical records, police reports, or other sources to evaluate claim validity.
  • Investigated customer inquiries, identified issues and provided solutions.
  • Checked into questionable claims, interviewing agents and claimants to resolve errors and omissions.
  • Discussed current cases and issues in claim committee meetings.
  • Verified liability extent with reviews of police reports, medical treatment histories and other records.
  • Input claim information and payments into company database.
  • Delivered exceptional customer service to clients by communicating information and actively listening to concerns.
  • Reviewed police reports, medical treatment records, medical bills and physical property damage to determine extent of liability.
  • Reduced loss ratios through fair and prompt processing of claims.
  • Analyzed information gathered by investigations and reported findings and recommendations.
  • Drafted statement of loss to summarize damages, payments and underlying policy coverage.
  • Gathered and documented evidence to support court proceedings.

Medical Only Claim Examiner

Crawford & Co / Broadsprei
Denver, CO
09.2004 - 09.2016
  • Documented all information regarding claim status in the database system.
  • Assessed claim accuracy according to company policies and procedures.
  • Prepared various reports documenting findings and recommendations regarding claims resolution.
  • Attended continuing education courses to stay abreast of best practices in the field.
  • Communicated with claimants, attorneys and other parties involved in the process.
  • Investigated customer inquiries, identified issues and provided solutions.
  • Verified claimant identity and reviewed information for completeness.
  • Participated in meetings with senior management team members to discuss trends in claims handling.
  • Advised customers on insurance coverage options available based on their needs.
  • Ensured compliance with applicable state laws, regulations and standards of practice.
  • Maintained detailed records of all activities related to each claim file.
  • Input claim information and payments into company database.
  • Reviewed police reports, medical treatment records, medical bills and physical property damage to determine extent of liability.

Claim Assistant

THE HARTFORD INSURANCE COMPANY
Denver, CO
06.1990 - 03.2004
  • Assisted in the preparation of documents for claims processing.
  • Answered inquiries from customers regarding their individual claims status.
  • Prepared detailed documentation supporting all activities related to each claim processed.
  • Ensured compliance with HIPAA regulations when dealing with confidential patient information.
  • Identified areas where processes could be improved upon in order to streamline operational workflow.
  • Performed quality control checks on completed files prior to final submission for payment authorization purposes.
  • Attended monthly meetings with upper management personnel in order discuss any outstanding challenges encountered while processing high volume workloads.
  • Managed incoming mail consisting of new applications and and or additional documentation required for existing open claims files.
  • Conducted research, when needed, into various types of policies, procedures, and regulations related to different types of claims.
  • Maintained accurate records related to all aspects of the claims process.
  • Performed data entry into internal systems to process claims requests.

Education

GED -

Chatfield Senior High
Littleton, CO
01-2017

Skills

  • Policy Interpretation
  • Insurance knowledge
  • Financial Acumen
  • Claims Investigation
  • Critical Thinking
  • Case Presentation

Accomplishments

  • Received several Work Tango points.
  • Received Prime performance awards.

Certification

  • Licensed In Arizona

Languages

English
Professional

References

References available upon request.

Timeline

Claim Examiner

Sedgwick
09.2016 - Current

Medical Only Claim Examiner

Crawford & Co / Broadsprei
09.2004 - 09.2016

Claim Assistant

THE HARTFORD INSURANCE COMPANY
06.1990 - 03.2004

GED -

Chatfield Senior High

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