Summary
Overview
Work History
Education
Skills
Certification
Timeline
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DURCKLYNE DAUPHIN

Altamonte Springs,FL

Summary

Detail-oriented professional with hands on experience in network technologies and security. Adept at installing network components, adding new lines and configuring components. Sets up, troubleshoots and optimizes peripheral devices. Proficient in updating software and hardware to meet performance demands.

Overview

14
14
years of professional experience
1
1
Certification

Work History

Casualty Claims Resolution Specialist

Liberty Mutual
05.2021 - Current
  • Investigates and evaluates coverage, liability, damages, and settles claims within prescribed authority levels
  • Identifies potential suspicious claims and refers to SIU and identifies opportunities for third party subrogation
  • Accountable for security of financial processing of claims, as well as security information contained in claims files
  • Makes effective use of loss management techniques
  • Negotiates settlements with attorneys, claimants, and/or co-defendants
  • Arranges for expert inspections involving third party or potential fraud actions as needed
  • Updates files and provides comprehensive reports as required.

EDI Claim Assistant

Amtrust Financial Services
08.2017 - 05.2021
  • Research Workers Compensation Claims in applicable claim system for information needed to complete EDI reports by reviewing claims based on State requirements
  • Review state websites for filing information, potential penalties or fines
  • Analyze any EDI errors and make necessary corrections as stipulated by state requirements
  • Create and submit EDI First Report of Injury and Subsequent Reports in EDI programs by sending toFlorida Division of Workers Compensation

Medicare Claim Specialist

Florida Hospital
05.2015 - 08.2017
  • Processes administrative appeals, refunds, reinstatements and rejections of insurance claims
  • Analyzes daily correspondence (denials, underpayments) to appropriately resolve issues
  • Maintained suspicious claims database and prepared reports on quarterly basis for supervisors.

Radiology Outpatient Scheduler

Florida Radiology Imaging
11.2013 - 05.2015
  • Accountable for accurately entering patient data into the system and ensuring that all required paperwork/prescriptions are received to process for the scheduled services

Customer Care

Professional, United Healthcare Group
10.2010 - 11.2013
  • Respond to and resolve on the first call, customer service inquires and issues by identifying the topic and type of assistance the caller needs such as benefits, eligibility and claims, financial spending accounts and correspondence.

Education

Master of Science - Networking Engineering

Southern Methodist University
Dallas, TX
05.2025

Bachelor of Science - Business Management

Daytona State College
Daytona Beach, FL
05.2019

Skills

  • Security Platforms
  • Network Device Monitoring
  • Linux
  • Verbal and Written Communication
  • Java
  • Technical Analysis
  • Troubleshooting computer hardware and networks
  • Network Infrastructure Administration
  • Microsoft Exchange
  • Python Scripting
  • Network Intelligence
  • Effective Communication
  • Data Analysis
  • Risk analysis

Certification

  • 620 adjuster License Florida Department of Financial Services-issued May 2021

Timeline

Casualty Claims Resolution Specialist

Liberty Mutual
05.2021 - Current

EDI Claim Assistant

Amtrust Financial Services
08.2017 - 05.2021

Medicare Claim Specialist

Florida Hospital
05.2015 - 08.2017

Radiology Outpatient Scheduler

Florida Radiology Imaging
11.2013 - 05.2015

Customer Care

Professional, United Healthcare Group
10.2010 - 11.2013

Master of Science - Networking Engineering

Southern Methodist University

Bachelor of Science - Business Management

Daytona State College

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DURCKLYNE DAUPHIN