DonnaLee Gulbranson
Escondido
Summary
Proficient Claims Associate skilled in handling high volumes of liability claims. Processes adjustments based on identifiable liability and coverage available. Supports work of senior team members by being able to multi-task and help others while still maintaining my work.
Overview
6
6
years of professional experience
Work History
Insurance Claims Specialist
GEICO
Poway, CA
01.2020 - Current
- Reviewed customer insurance claims to ensure accuracy and completeness of information.
- Analyzed claim records, policy provisions, and other relevant documents to determine validity of claims.
- Assisted customers in filing new insurance claims and provided status updates on existing ones.
- Investigated suspicious or fraudulent claims and reported findings to Special Investigations Unit.
- Provided guidance to customers regarding their coverage available to them under their insurance policies.
- Resolved customer complaints related to insurance claim processing.
- Maintained detailed records of all claim activities, with proper claim documentation, including correspondence, decisions, payments.
- Advised customers on how they can protect themselves from potential risks associated with their policies.
- Ensured compliance with state laws governing insurance practices as well as company policies and procedures.
- Processed requests for additional documentation from customers in a timely manner.
- Coordinated with external parties such as lawyers, surveyors, appraisers during investigations.
- Determined liability and coverage due on each claim.
- Processed Liability claims daily and expertly handled as many files as I could with an average above 30 QCR with impeccable quality.
- Maintained knowledge of policies and procedures and insurance coverage benefit levels, eligibility systems and verification processes.
- Communicated with other departments to establish action plans and manage open claims to closure.
- Conducted interviews with involved claims parties and witnesses to gather detailed information and arrange investigations.
- Determined covered insurance losses by studying provisions of policies or certificates.
- Assisted claimants, providers and clients with problems or questions regarding claims.
- Processed claims for payment or forwarded to appropriate personnel for further investigation
- Transcribed data to worksheets and entered data into computer to update the claims properly
Medical Receptionist
Regional Orthopedics
Cherry Hill, NJ
10.2018 - 07.2019
- Greeted and checked in patients, updating patient information in computer system.
- Verified insurance coverage for appointments and collected co-payments as required.
- Scheduled patient appointments, verifying accuracy of appointment times with providers.
- Answered incoming calls, responding to inquiries from patients and other medical offices.
- Prepared charts for new patients, ensuring all necessary forms were completed correctly.
- Assisted with filing of medical records and documents, maintaining accurate electronic files.
- Provided support to clinical staff during patient visits, including rooming patients, collecting vital signs and documenting chief complaints.
- Performed data entry tasks related to billing and collections procedures.
- Processed referrals for specialist care when requested by physicians or patients.
- Checked patients in and out for appointments and collected co-payments.
- Carried out daily tasks by professionally communicating with physicians, nursing staff, technicians and medical assistants.
- Trained new staff on office procedures, insurance processes and medical terminology.
- Applied knowledge of medical terminology and insurance processes to support office administration productivity.
- Scheduled tests, lab work or x-rays for patients based on physician orders.
- Worked with multiple auto insurance companies to get treatment approved.
Education
Some College (No Degree) - Accounting And Business Management
Ashford University
Chandler, AZSkills
- Claims Investigation
- Insurance knowledge
- Policy Interpretation
- Documentation Review
- Accident Investigations
- Verbal Communication
- Microsoft Office
- Allocating claims
- Claims Processing
- Customer Service
- Teamwork and Collaboration
- Data Entry
- Multitasking
- Insurance Coverage Verification
- Time management abilities
- Professionalism
- Self Motivation
- Continuous Improvement
Timeline
Insurance Claims Specialist
GEICO
01.2020 - Current
Medical Receptionist
Regional Orthopedics
10.2018 - 07.2019
Some College (No Degree) - Accounting And Business Management
Ashford University