Heather Wingard
Bay Minette
Summary
Detail-oriented Claims Examiner with expertise in claims processing, policy interpretation, and customer support. Proven ability to analyze complex claims and ensure timely resolutions, enhancing overall customer satisfaction.
Results-driven Claims Examiner skilled in critical thinking, investigative analysis, and decision-making. Successfully reduced claim processing time through efficient workflow strategies while maintaining high standards of accuracy and compliance.
Dedicated professional with strong claims evaluation and customer service skills. Experienced in interpreting insurance policies and resolving complex claims, committed to ensuring compliance and enhancing client satisfaction.
Professional with comprehensive experience in claims processing and evaluation. Demonstrates strong analytical skills, thorough knowledge of insurance policies, and consistent track record of identifying and resolving complex claims. Valued team player with strong focus on collaboration and results, adaptable to evolving work environments. Known for reliability, problem-solving abilities, and effective communication with stakeholders.
Overview
3
3
years of professional experience
Work History
Claims Examiner III
Pilot Catastrophe Services
Mobile, AL
07.2023 - Current
- Analyzed insurance claims for accuracy and compliance with company policies.
- Processed complex claims, ensuring timely resolution and customer satisfaction.
- Collaborated with adjusters to gather necessary documentation for claim evaluations.
- Reviewed policy coverage details to determine claim eligibility and potential payout amounts.
- Maintained detailed records of all claims activities in company database systems.
- Handled sensitive information with discretion, ensuring confidentiality of personal and financial details for claimants throughout the claims examination process.
- Reduced claim processing time by implementing efficient workflow strategies and prioritizing tasks effectively.
- Enhanced customer satisfaction by promptly addressing inquiries and providing accurate information on claim status.
- Maintained detailed records of all claims activities, ensuring compliance with regulatory requirements and company policies.
- Interpreted policy provisions, endorsements, and exclusions to accurately determine coverage for claims.
- Researched claims and incident information to deliver solutions and resolve problems.
- Provided exceptional customer service by empathetically addressing claimants'' concerns and effectively explaining the claims process to them.
- Maintained current knowledge of industry developments, regulations, and best practices through continuous professional development activities.
- Examined photographs and statements.
- Conducted thorough investigations of complex claims, gathering relevant documentation and interviewing witnesses when necessary.
- Managed caseloads effectively while maintaining high-quality work standards and meeting strict deadlines consistently.
- Read over insurance policies to ascertain levels of coverage and determine whether claims would receive approvals or denials.
- Conducted day-to-day administrative tasks to maintain information files and process paperwork.
- Examined claims forms and other records to determine insurance coverage.
- Identified insurance coverage limitations with thorough examinations of claims documentation and related records.
- Delivered exceptional customer service to policyholders by communicating important information and patiently listening to issues.
- Evaluated original investigation reports and documents to resolve secondary concerns.
- Maintained claims data in DuckCreek systems.
- Investigated and assessed damage to property and reviewed property damage estimates.
Education
High School Diploma -
Shevington High School
Shevington United KingdomSkills
- Claims processing
- Verbal communication
- Data verification
- Microsoft Office Suite
- Policy interpretation
- Liability and coverage
- Investigative skills
- Coverage analysis
- Claims evaluation
- Computer skills
- Decision-making
- Customer service and support
- Payment processing
- Critical thinking
Timeline
Claims Examiner III
Pilot Catastrophe Services
07.2023 - Current
High School Diploma -
Shevington High School