Fabiola Pierre
Plantation
Overview
10
10
years of professional experience
Work History
Claim Specialist
State Farm
08.2022 - Current
- Leverage company software for claims tracking, achieving a 100% rate of adherence to claims processing timelines.
- Investigate and settle 500+ automobile claims quarterly while maintaining highest standards of call quality and service.
- Calculate loss payments and approved payment of claims within a $150,000 limit.
- Evaluate and negotiate settlements of automobiles, first and third party physical damage claims within established settlement authority limits and negotiate any excessive storage charges; provide rental termination information to first and third parties.
- Conduct loss investigations, screened vehicles, research missing information on claims and process payments. Follow up on inconsistencies and missing information.
- Provide coordination with internal functions to include appraisal operations, SIU, Region Counsel, Subrogation, and closely work with Salvage for titling and alternative disposals of vehicle total losses as needed.
Humana Claim Specialist
Conduent
07.2021 - 08.2022
- Handled telephone calls, wrote letters, and sent faxes to insurance carriers, patients, and other responsible parties in the pursuit of getting a claim resolved.
- Investigated and settled claims and customer service issues. Decisions typically focused on interpretation of area/department policy and methods for completing assignments.
- Worked within defined parameters to identify work expectations and quality standards, but has some latitude over prioritization/timing, and worked under minimal direction.
- Initiated coordination of care documents on behalf of patients.
- Helped guide and educate customers on their prescription benefits, use of plan, formulary, premiums and status of orders, and claims or inquiries.
- Possessed an accurate knowledge of CPT, ICD-9 and HCPS codes.
- Resolved medical claims by approving or denying per documentation, calculated benefits due, initiated payments or composed denial letters.
- Cooperated with Medicare, Medicaid, and private insurance providers to resolve billing issues.
Administrative Assistant
Florida A&M University
08.2014 - 05.2019
- Greeted visitors, answer phones, and direct inquiries.
- Prepared and tracked purchase orders and invoices.
- Maintained filing systems, databases, and information systems.
- Coordinated office moves, supplies orders, and setup of IT systems.
- Ensured compliance with administrative policies and procedures.
- Managed and organized databases and electronic records.
- Researched, analyzed, and compiled information for business reports.
- Created and updated spreadsheets, presentations, forms, and databases.
- Collaborated with other departments on ongoing projects.
Education
Bachelor of Science -
Florida A&M University
Claims Adjuster - All Lines Adjuster - ACA Designation -
Educational Services And Consulting LLC
Skills
- Policy Interpretation
- Legal Compliance
- Financial Acumen
- Claims Investigation
- Claims Processing
- Coverage Determination
- Data Entry
- Recordkeeping Organization
- Google Suite Proficiency
- CCC
- Lexis Nexis
- Data Analysis
- Quality Assurance
Timeline
Claim Specialist
State Farm
08.2022 - Current
Humana Claim Specialist
Conduent
07.2021 - 08.2022
Administrative Assistant
Florida A&M University
08.2014 - 05.2019
Bachelor of Science -
Florida A&M University
Claims Adjuster - All Lines Adjuster - ACA Designation -
Educational Services And Consulting LLC
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