Jena Vahdatpour
Sanford,FL
Summary
Experienced administrative professional with excellent customer service, analytical, and problem-solving skills. Looking to join a challenging role within a growing team to contribute to the company's success.
Overview
12
12
years of professional experience
Work History
CLAIMS ASSISTANT
Insurance Company of the West
10.2023 - 04.2024
- Reviewing and entering financial information such as reserve information, processing daily payroll indemnity checks, issuing payments from defense counsel, experts, and settlement payments.
- Verifying and analyzing data used in settlement claims to ensure that claims and settlements are made by corporate, State, and client policy and procedure.
- Initiation and follow-up for Workers' Compensation procedures and treatment authorizations.
- Report preparation and completion for clients and internal analysis based on medical records and bills.
- Complete specialized projects assigned that include legal research.
- Assisted over six adjusters in gathering critical information for accurate evaluations of loss events and damage estimates.
- Prepared files, letters, and notices.
- Schedule appointments and collect necessary information for data entry, treatment, and billing purposes.
INSURANCE OPERATIONS PROCESSOR
Oscar Health
11.2021 - 07.2023
- Analyze data for claims adjudication to ensure accuracy, using this data to make decisions daily.
- Conduct training classes for various life cycles of the claims process with an emphasis on provider disputes, billing, and eligibility.
- Develop visual workflow materials for training classes.
- Provide one-on-one coaching and peer support for both starting and on-the-job performance.
- Auditing and scheduling staff duties.
- Check monthly reports and analyze billing data to identify trends and discrepancies.
- Prepare itemized statements, bills, and invoices, and record amounts due for items purchased and services rendered.
- Developed and implemented effective billing processes to improve accuracy and efficiency.
- Collaborate with business partners to resolve, improve, and implement solutions.
MEDICAL CLAIMS ADJUSTER
Progressive Insurance
03.2021 - 08.2021
- Interviewed witnesses, customers, attorneys, providers, and claimants.
- Documented injury-related treatment, lost wages, and other expense histories to ensure an accurate claim file.
- Utilized IME and Peer Review processes when it was appropriate.
- Authorized payments to providers and eligible parties based on analyzed medical bills and records, lost wages, and other expense claims submitted.
- Researched and interpreted injury-related statutory provisions and case law; examined points of impact and extent of damage relative to the mechanism of injury claimed; ran reports for prior injury information.
- Obtained proper release documentation and statements; acquired detailed medical reports, medical bills, wages, and other expense information and conducted detailed research relating to damages submitted for payment.
- Used medical billing knowledge to understand and effectively interpret payer contracts, remittances, and explanation of benefits (EOB) statements.
PERSONAL LINES UNDERWRITER
Farmers Insurance
06.2019 - 01.2020
- Recognized problems, issues, and improvement possibilities.
- Summarize information and make recommendations based on policy guidelines.
- Balanced risk relative to return to make effective and acceptable underwriting decisions.
- Responsible for accurate premium registration and invoicing, coding, pricing, and commission calculations for insurance agents.
- Strategically reviewed files, and collected missing documents, signatures, and all requirements to complete and bind a policy.
- Collaborated with internal departments to develop and maintain underwriting standards and procedures.
AUTO PRODUCT SPECIALIST
AAA - Auto Club Group Inc
07.2012 - 05.2019
- In a leadership and quality role, managed and conducted new hire on-the-job training classes of 15-20 in size.
- Scored and monitored new hire and complaint calls, providing feedback on de-escalation techniques and customer service etiquette.
- Managed Damage, Service Repair Shop, Inter-club, claims/complaints, providing end solutions with business needs staying intact.
- Front Line In-Take Claim assistance also provides support through the claim process for both the client and vendors
- Provided technical support assistance for the vast contractor network for various states.
- Quickly and efficiently manage complex internal and external complaints with a member complaints resolution rate of 99.9% annually.
- Workforce Management, reviewing call queues for average handle time and availability.
- Monitored emergency dispatch board in a leadership capacity, delegating emergency actions as required, and ensuring emergency arrival times.
Education
GED -
Seminole State
Sanford, FLSkills
- Microsoft Office/Google Suites
- Tracking spreadsheets
- JIRA-Project Management/CRM
- Blackbird- Data Collection
- Leadership
- HIPAA compliance
- Medical Billing
- Medical Terminology
Timeline
CLAIMS ASSISTANT
Insurance Company of the West
10.2023 - 04.2024
INSURANCE OPERATIONS PROCESSOR
Oscar Health
11.2021 - 07.2023
MEDICAL CLAIMS ADJUSTER
Progressive Insurance
03.2021 - 08.2021
PERSONAL LINES UNDERWRITER
Farmers Insurance
06.2019 - 01.2020
AUTO PRODUCT SPECIALIST
AAA - Auto Club Group Inc
07.2012 - 05.2019
GED -
Seminole State
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