Heather Sintobin
Summary
Experienced and empathetic insurance claims professional with a strong background in conflict resolution, negotiation, and delivering exceptional customer care. Seeking opportunities in account management, customer care, or the insurance industry. Skilled in mentoring and training others, with strong relationships with clients, vendors, and agents. Self-motivated and adaptable to change, possessing excellent written and verbal communication skills.
Overview
25
25
years of professional experience
1
1
Certification
Work History
Billing Specialist
PrimaryOne Health
09.2021 - Current
- Reviews all claims for completeness and accuracy before releasing claim
- Review provider notes from patient's visits to make sure the assigned diagnosis and CPT codes are accurate, Current, and adhere with the diagnosed aliment(s) prior to submitting bill
- Assist customers with billing questions
- Researches and corrects received denials
- Documents all correspondence with patients, insurance carriers, and vendors
- Submit daily correspondence requests to providers when billing corrections are needed
Claims Examiner-Bodily Injury
Sedgwick CMS
09.2019 - 12.2020
- Company Overview: Remote position
- Processed commercial auto claims for a nationwide rental car company
- Investigated & conducted recorded statements & interviews; determined liability; resolved, negotiated & settled bodily injury claims; reviewed medical records & bills to negotiate attorney demands for injury settlements
- Submitted new claim notices to Medicare & Medicaid with proper CPT diagnosis; reviewed ICD 10 & CPT codes to confirm accurate & related charges; complied with HIPAA regulations & adhered multiple state standards & regulations
- Accurately evaluated & set initial reserves, & adjusted reserves as needed for each claim
- Developed & maintained action plans to ensure state required deadlines were adhered to; moved files to prompt & appropriate resolutions
- Identified subrogation opportunities, as well as monitored claims for fraudulent activity; made referrals to SIU
Commercial Claims Examiner
Rightsourcing, Inc.
05.2019 - 07.2019
- Company Overview: Contract Employee for Sedgwick CMS
- Processed commercial auto claims for a global transportation company account
- Conducted the same tasks as listed in the previous position; adhered to proper reserving processes; negotiated settlements; monitored for subrogation opportunities, & possible fraud
- Assessed damage estimates for claimant vehicles & for the client's commercial vehicles; issued proper repair & total loss settlements to claimants & body shops
- Maintained professional client relationships, & communicated the status of claims to the client & agent or broker when needed
- Arranged rental accommodations for third party clients
- Ensured state statutes were followed & required deadlines were met
- Utilized analytical skills to evaluate medical bills for accuracy and appropriateness of charges before approving payments as part of the claims process.
Branch Claims Adjuster
Auto-Owners Insurance
01.2016 - 02.2019
- Initiate coverage verification and depict all claims made by clients to ensure they adhere to company policy
- Investigate, analyze and adjust all claims presented to Auto-Owners via first and third party clients
- Work closely with all customers to ensure they receive appropriate adjustments for their auto claim whether it pertains to a repairable vehicle, a total loss settlement, or a customer retaining a salvage vehicle
- Organize and accommodate rental agreements for all clients
- Monitor and review medical bills and records, as well as negotiate and settle bodily injury claims with claimants and/or their attorneys (includes BI, UM, and UIM claims)
- Adhere to Medicare and Medicaid guidelines which includes preparing and sending proper documents, as well distributing clients medical payments
- Retain defense and/or coverage counsel for litigated files to represent Auto-Owners or our insured(s), as well as work closely with them throughout the case; prepare legal reports for continued communication(s) for our home office legal group and home office trucking group to be reviewed
- Attend mediation and pre-trial hearings with defense counsel from multiple firms in attempt to settle litigated claims
- Examined claims forms and other records to determine insurance coverage.
Life Insurance Service Advocate
Farmers Insurance Group
05.2015 - 01.2016
- Communicated daily with agents, policyholders and third party financial institutions
- Maintained extensive knowledge of term, whole life, and universal products; having basic understanding of underwriting, reinstatements, conversions, and billing
- Analyzed, clarified, and resolved policy related inquiries for new business policies
- Improved customer satisfaction by promptly addressing inquiries and resolving issues
- Maintained a daily average of 60+ incoming calls per day
Administrative Assistant
Ashland University
08.2014 - 04.2015
- Assisted students with registering for education classes, as well as for their field experience(s), and student teaching assignments at different school districts
- Prepared field placements packets and student teaching handbooks for the Field Placement Coordinator; Assisted with placing student teachers at local school districts in order to complete their field placement courses and/or student teaching requirements
- Maintained academic database of grades and placement test scores of all education students, as well as scheduled their state required background tests and maintained those records
- Organized and administered semester payments to the education field supervisors, student teaching supervisors, as well as for the adjunct professors
- Frequently collaborated with the Dean of Education's office at Ashland University's main campus
Corporate IT Recruiter
Randstad Technologies
04.2014 - 07.2014
- Actively recruited and interviewed IT professionals seeking a new IT profession
- Generated leads by conducting research via LINKEDIN, Bullhorn, and CareerBuilder
- Conducted telephone and in-house interviews, as well as coached and mentored candidates
- Negotiated salaries with candidates and hiring managers
- Conducted initial recruitment calls and sales meetings with hiring managers
Agency Career Specialist Recruiter
Farmers Insurance Group
05.2013 - 04.2014
- Actively recruited using various forms of social media and recruitment databases
- Consistently consulted and interviewed high net worth entrepreneurs looking to opening insurance agencies in Ohio
- Facilitated and organized background checks for all potential employees
- Prepared and communicated all weekly sales reports to upper management
- Selected and actively participated on the state leadership management team
- Created and delivered detailed presentations to our executive leadership team
- Frequently traveled Ohio to collaborate with active sales agencies to help promote an increase in sales
- Attended recruiting and marketing events across Ohio's numerous college campuses
Claims Specialist II Total Loss Department
Nationwide Insurance
12.2009 - 05.2013
- Same position requirements as previously listed below for Nationwide Insurance
- Conducted claims investigations and settled claims primarily for NC and SC, however frequently assisted with handling, negotiating and settling claims for numerous other states
- Worked catastrophe duty, (CAT duty)
- Completed Arbitration Forums panelist training to hear Arb cases, as well as prepared, responded to, and submitted contentions
Senior Account Manager
NetJets
01.2005 - 09.2009
- Collaborated with high-end clients to ensure maximum customer service; Coordinated private reservations for domestic & international flights
- Successfully managed logistics for 30+ flights, including ground travel and catering; Compiled price quotes, contract/billing inquiries, and flight summary reports on a daily basis
- Resolved current day flight situations with management for owner travel; problem solved logistic & weather issues in conjunction with the pilots, dispatchers, scheduling, meteorologists, Sr. Management & sales V.P's, and kept the clientele informed
- Negotiated with clientele regarding the use of subcontracted private jets on peak travel dates
- Arranged departure & arrival slots for high traffic airports & for international travel
- Submitted requests to customs offices to obtain approval for the flight arrivals & departures for clients (and pets)
- 'Go-Team-First Responders' member. Responsible for responding to emergency situations and providing support in case of a jet accident
- Developed long-lasting client relationships by providing exceptional customer service and support.
- Attended frequent training with the NTSB, Red Cross, flight attendants and clergy
Liability and Fire & Theft Adjuster
Nationwide Insurance
09.1999 - 12.2004
- Verified coverage and addressed all coverage and claim related issues
- Conducted claims investigations via recorded interviews and determined liability
- Negotiated and settled offers with policyholders, claimants and their attorneys
- Monitored rental car reservations, as well as reservation payments
- Negotiated storage payments, towing bills, and conducted market comparison value reports for total loss claims and properly managed salvage
- Organized daily claim activities and initiated same day contact with customers, as well as organized mail and electronic correspondences
- Collaborated closely with the special investigation unit on all fraudulent claims; collaborated with legal counsel as well as underwriting and agents
- Conducted fire and theft investigations via recorded interviews for OH and WV; investigated and reported fraud; initiated Origin and Cause investigations to be completed
- Worked catastrophe duty, (CAT duty)
Education
Bachelor of Arts - General Studies, Social Sciences and Criminal Justice
Kent State University
Kent, OH08.1999
Certification in Medical Insurance Billing and Coding -
Larock Healthcare Academy
Columbus, OH08.2021
Skills
- Negotiation skills
- Complex Problem-solving
- Assertiveness
- Client management
- Advanced oral and written communication skills
- Customer and client relations
- Problem-solving skills
- Conflict Resolution
- Personal service background
- Highly motivated
- Best practices implementation
- Billing systems and software
- Month-end closing procedures
- Data entry proficiency
Certification
- Previously held West Virginia & North Carolina non-resident adjuster's license
- Legal Principles Claim Specialist (LPCS) designation, 2019
- Dale Carnegie Relationship Building and Leadership Development, Completed Fall 2017
Affiliations
- Alpha Omicron Pi
- National Association of Professional Women
Timeline
Billing Specialist
PrimaryOne Health
09.2021 - Current
Claims Examiner-Bodily Injury
Sedgwick CMS
09.2019 - 12.2020
Commercial Claims Examiner
Rightsourcing, Inc.
05.2019 - 07.2019
Branch Claims Adjuster
Auto-Owners Insurance
01.2016 - 02.2019
Life Insurance Service Advocate
Farmers Insurance Group
05.2015 - 01.2016
Administrative Assistant
Ashland University
08.2014 - 04.2015
Corporate IT Recruiter
Randstad Technologies
04.2014 - 07.2014
Agency Career Specialist Recruiter
Farmers Insurance Group
05.2013 - 04.2014
Claims Specialist II Total Loss Department
Nationwide Insurance
12.2009 - 05.2013
Senior Account Manager
NetJets
01.2005 - 09.2009
Liability and Fire & Theft Adjuster
Nationwide Insurance
09.1999 - 12.2004
Certification in Medical Insurance Billing and Coding -
Larock Healthcare Academy
Bachelor of Arts - General Studies, Social Sciences and Criminal Justice
Kent State University
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