Janiris Anderson
Insurance Professional
Flanders,NJ
Summary
Resourceful Insurance Specialist offering expertise in problem-solving, data analysis and customer service. Adept at quickly learning new technologies and processes for driving success. Proven track record of successfully managing heavy workloads and promoting a health work environment.
Overview
19
19
years of professional experience
4
4
years of post-secondary education
1
1
Language
Work History
Commercial PIP Specialist II - Multi-State
MOBILITAS INSURANCE COMPANY
07.2023 - 04.2024
- Maintain compliance with state regulatory requirements through meticulous documentation and adherence to company policies
- Analyze policy details along with supporting documents provided by healthcare providers to make informed decisions on claims approvals or denials
- Reduce claim processing time by streamlining medical claims adjudication processes by maintaining 150-200 claims
- Evaluate any potential for subrogation and initiate initial notice of subrogation request
- Manage high volume caseloads, prioritizing urgent and sensitive cases for immediate attention
- Maintained strict compliance with HIPAA regulations, safeguarding patient privacy throughout claim evaluation process
- Improved customer satisfaction rates through proactive problem-solving and efficient complaint resolution.
Commercial Casualty Specialist
MOBILITAS INSURANCE COMPANY
08.2022 - 07.2023
- Conducted thorough investigations, gathering evidence such as medical records, police reports, and witness statements to determine liability accurately
- Evaluate any potential for subrogation and initiate initial notice of subrogation request
- Coordinated independent medical examinations to verify injury severity when required
- Maintain open communication relaying pertinent case data to corresponding escalating party/parties
- Assisted colleagues in resolving complex coverage issues or difficult negotiations, fostering supportive work environment that promoted teamwork and knowledge sharing
- Maintained comprehensive documentation for each claim in database system, improving overall organization and efficiency within department.
PIP Med Pay Claim Representative
NJM INSURANCE GROUP
06.2016 - 08.2022
- Execute tasks by navigating multiple systems concurrently to service Spanish Bilingual claimants
- Investigate and ensure claimants are afforded appropriate coverage that are legally liable to insure
- Process Medicare and Health Insurance Liens by determining coverage eligibility, processing disputes and processing reimbursements on case-by-case basis
- Review treatment requests and process medical payments ensuring ICD codes and CPT codes are auto injury related and medically necessary
- Actively participate in team huddles and training sessions to take every opportunity available to improve business processes
- Promote and take initiative in team building exercises to maintain productive & positive working environment.
Personal Lines Customer Service Representative
NJM INSURANCE GROUP
07.2007 - 06.2016
- Built strong rapport with customers to ensure that service meets & exceeds their expectations
- Maintained 90-100% evaluation scores by providing excellent Spanish Bilingual customer service and excelled in delivering first call resolutions
- Motivate and take initiative in team building exercises to promote happy & healthy work environment
- Assisted trainer with technical support and introducing new systems and procedures to colleagues.
Processing Clerk/Bank Customer Service Representative
NJM INSURANCE GROUP
05.2006 - 07.2007
- Processed incoming correspondence, claim payments, and provided administrative support to each department assigned as needed
- Assisted prospective and existing customers with their individual banking needs
- Offered multiple banking products and services that would best match customer's needs.
Legal File Clerk
NJM INSURANCE GROUP
02.2005 - 05.2006
- Delivered correspondence and provided multi-line phone coverage in the P.D
- Dept
- Created reports and produced legal documents requiring Spanish translation
- Provided administrative and clerical support to the Legal Dept
- As needed.
Education
High School Diploma -
Dover High School
NJ, 07801 09.1999 - 05.2003
Skills
Comfortable with Adobe Softwareundefined
Timeline
Commercial PIP Specialist II - Multi-State
MOBILITAS INSURANCE COMPANY
07.2023 - 04.2024
Commercial Casualty Specialist
MOBILITAS INSURANCE COMPANY
08.2022 - 07.2023
PIP Med Pay Claim Representative
NJM INSURANCE GROUP
06.2016 - 08.2022
Personal Lines Customer Service Representative
NJM INSURANCE GROUP
07.2007 - 06.2016
Processing Clerk/Bank Customer Service Representative
NJM INSURANCE GROUP
05.2006 - 07.2007
Legal File Clerk
NJM INSURANCE GROUP
02.2005 - 05.2006
High School Diploma -
Dover High School
09.1999 - 05.2003