Fanchon Brown

• Serve as first level of contact for Customer Service managing approximately 40 incoming calls and emails per day from customers
• Take first notice of loss reports, accurately enter new loss information into claim system and route claims for assignment to adjuster.
• Completing daily Tasks to process claim in timely manner. Made weekly Outbound calls to follow up with status / questions. Respond to emails and uploaded any attached supporting documentations to claim file for review.
• Drafted initial inquiries contact letters, gather policy documents, order police reports and coordinate vendor assignments.
• Managed initial customer service inquiries, efficiently processing first notice of loss reports and entering new loss information into claims system for accurate routing.
• Post financial transactions such as salvage, subrogation and deductible recoveries into claim system.
• Assist adjusters with SIU referrals, acknowledgement letters, Coverage Determination Calls and vendor payments.

• Served as first point of contact for policy holder's and third-party inquiries daily, providing prompt and professional support.
• Processed 50+ First Notices of Loss (FNOL) per day, accurately entering loss data into claims system and efficiently routing cases to Adjusters.
• Drafted and sent initial contact letters daily, gathered policy documents, ordered police reports, and coordinated vendor assignments to expedite claims processing.
• Posted and reconciled financial transactions, including salvage, subrogation, and deductible recoveries, ensuring compliance with financial protocols.
• Prepared acknowledgment letters, and processed vendor payments to support timely claim resolution.

• Contacted policyholders to explain claims process, policy coverages, damages, deductibles, and supplement procedures, ensuring clarity and setting up inspections with field adjusters.
• Researched insurance policies, reviewed reports and photos, evaluated damages, and authorized payments.
• Reviewed claim details, coverage limits, estimates, and all associated damages.
• Adjusted reserves as needed to accurately reflect financial exposure, ensuring proper claim valuation and risk assessment.

Mobile Home Total Loss Unit

• Contacted policyholders to explain claims process, policy coverages, damages, deductibles, and supplement procedures, ensuring clarity and setting up inspections with field adjusters.
• Researched insurance policies, reviewed reports and photos, evaluated damages, and authorized payments.
• Reviewed claim details, coverage limits, estimates, and all associated damages.
• Conducted in-depth claims research, including direct outreach to Insures and Contractors to gather missing information and facilitate accurate claim processing.
• Adjusted reserves as needed to accurately reflect financial exposure, ensuring proper claim valuation and risk assessment.

• Managed high volume of claims and handled 100+ customer calls daily in fast-paced, collaborative team environment.
• Processed First Notice of Loss (FNOL) forms for auto accidents, ensuring timely and efficient claim initiation.
• Coordinated with internal and external partners to support policyholders throughout claims process, ensuring seamless communication and resolution.
• Researched insurance policies, reviewed reports and photos, evaluated damages, and authorized claim payments.
• Provided empathetic customer service, conducting proactive follow-ups to confirm that policyholder needs were met, and issues were fully resolved.

• Served as first point of contact for patient inquiries daily, assessing call purpose, prioritizing concerns, and efficiently triaging calls to appropriate departments.
• Resolved billing inquiries by clearly explaining benefits coverage, claims status, and problem-solving processes, ensuring 95%+ customer satisfaction.
• Investigated and resolved claim discrepancies within mandatory timeframes, maintaining full compliance with industry regulations and company policies.
• Managed and coordinated internal and external communication among staff, patients, and providers, ensuring seamless information flow and minimizing response delays.

• Initiated and conducted timely verbal outreach to Insurance carriers to clarify and resolve complaints and appeals efficiently.
• Conducted in-depth claims research, including direct outreach to providers and members, to gather missing information and facilitate accurate claim processing.
• Facilitated resolution of open appeals per day by reviewing claim coding, product specifications, contract terms, payment agreements, fee schedules, and authorization details.
• Arranged and negotiated repayment plans tailored to customers’ financial situations, ensuring compliance with company policies and regulatory guidelines.
• Processed appeals and grievances ensuring proper administration of benefits and clinical policies while adhering to all regulatory requirements.

• Resolving 100+ complex inquiries daily regarding insurance claims, payments, memberships, plan benefits and policies.
• Verified and updated provider records in real time, maintaining data accuracy by capturing new demographic details at the point of contact.
• Improved customer satisfaction by promptly addressing inquiries and resolving issues.
• Processes claims and re-evaluation requests.
• Identifies the prognosis of submitted services/claims and approves/denies based on standard guidelines.
• Returns provider’s calls to discuss denials, policies and contractual limitations.
• Reviews and analyzes documentation related to patient complaints.
• Prepares draft responses to internal staff pertaining to enrolled and provider grievances and appeals.
• Requests refunds from providers.