Haley Burton
Lawrenceville,GA
Summary
Possesses versatile skills in project management, problem-solving, and collaboration. Brings fresh perspective and strong commitment to quality and success. Recognized for adaptability and proactive approach in delivering effective solutions.
Overview
6
6
years of professional experience
Work History
Claims Adjuster
Progressive Insurance
11.2023 - Current
- Evaluated auto claims to determine coverage and liability based on policy guidelines.
- Utilized claims management software to track progress and maintain accurate records of all claims.
- Acted as a reliable point of contact for customers throughout the claims process, addressing their concerns with empathy and professionalism.
- Established an effective system for tracking and monitoring claims from initial report to final resolution, ensuring timely updates were provided to all relevant parties.
- Utilized strong negotiation skills to settle disputed liability cases in a fair and reasonable manner, ultimately minimizing company exposure to financial risk.
- Assisted clients with navigating complex insurance policies, ensuring they understood the extent of their coverage and benefits available to them during the claims process.
- Ensured regulatory compliance in all aspects of the auto claims process by staying up-to-date on industry laws and regulations.
- Coordinated with law enforcement and legal teams to gather necessary documentation for fraud investigations.
- Coordinated with local body shops to assign repair jobs and obtained rental vehicles for customers for duration of restoration process.
- Carried and managed consistently heavy project workload through exemplary organizational, time management and collaboration talents.
- Conducted thorough investigations to identify subrogation opportunities and gather supporting evidence.
Grievance & Appeals Escalation Coordinator
Delta Dental Insurance
10.2022 - 09.2023
- Coordinated claims processing to ensure timely resolutions and customer satisfaction.
- Managed communication between dental providers and clients, enhancing service delivery efficiency.
- Collaborated with cross-functional teams to facilitate timely resolution of disputes.
- Analyzed case documentation for accuracy and completeness, improving processing efficiency.
- Maintained detailed records of appeals and resolutions to support audits and reporting.
- Provided expert guidance to clients regarding appeal rights and procedures, enhancing client satisfaction.
- Implemented process improvements that reduced turnaround times for appeal resolutions.
- Conducted thorough investigations for complex cases, ensuring fair and accurate outcomes.
Level I & Level II Customer Service Advocate
Delta Dental Insurance
10.2020 - 10.2022
- Resolved customer inquiries regarding dental insurance plans and benefits.
- Promoted superior experience by addressing customer concerns, demonstrating empathy, and resolving problems swiftly.
- Helped large volume of customers every day with positive attitude and focus on customer satisfaction.
- Supported call center associates by taking on escalated calls, handling complex concerns and achieving customer satisfaction targets.
- Participated in regular performance evaluations, consistently exceeding expectations in key metrics such as first-call resolution rate.
- Adapted quickly to changes in company policies or systems, ensuring minimal disruption in service delivery during transitions.
- Followed up with customers about resolved issues to maintain high standards of customer service.
Education
High School Diploma -
Oil City Senior High
Oil City, PABachelor of Science - Healthcare Administration
Southern New Hampshire University
Hooksett, NH10-2027
Certification - Clinical Medical Assistant - Billing & Coding
Pennsylvania State University - Behrend
Erie, PA03-2019
Skills
- Insurance & Claims Expertise: Comprehensive proficiency in claims investigation, accident scene analysis, and liability assessment Skilled in policy analysis, coverage evaluations, and settlement negotiations
- Regulatory Compliance: Expert in maintaining legal and regulatory compliance, including insurance fraud detection and implementation of industry best practices
- Healthcare Administration: Proficient in the Healthcare Common Procedure Coding System (HCPCS) and clinical documentation
- Operational Management: Strong background in caseload organization, workload prioritization, and workflow optimization
- Communication & Conflict Resolution: Exceptional oral and written communication skills tailored for customer engagement and complex conflict resolution
- Technical Proficiency: Advanced computer application skills with a focus on data entry and claims file documentation
- Professional Attributes: A driven professional recognized for logical evaluation, informed decision-making, and high emotional intelligence (empathy and patience)
Timeline
Claims Adjuster
Progressive Insurance
11.2023 - Current
Grievance & Appeals Escalation Coordinator
Delta Dental Insurance
10.2022 - 09.2023
Level I & Level II Customer Service Advocate
Delta Dental Insurance
10.2020 - 10.2022
High School Diploma -
Oil City Senior High
Bachelor of Science - Healthcare Administration
Southern New Hampshire University
Certification - Clinical Medical Assistant - Billing & Coding
Pennsylvania State University - Behrend