Jessica Rudd
Walkersville,MD
Summary
Driven insurance professional experienced in investigating and processing automobile insurance claims. Energetic and enthusiastic, motivated to succeed in a fast-paced and deadline-driven environment. Exceptional skills in problem solving and analyzing damages and injuries with an extensive knowledge of auto policies and state specific rules and regulations. Positive attitude and analytical thinker with high-level skills in resolving claims and negotiating payment solutions to the satisfaction of all involved parties. Licensed Claims Adjuster focused on providing exemplary customer service.
Overview
12
12
years of professional experience
Work History
Medical Claims Representative
Progressive Insurance Company
09.2021 - Current
- Maintained knowledge of benefits claim processing, claims principles, medical terminology, and procedures and HIPAA regulations.
- Verified patient insurance coverage and benefits for medical claims.
- Managed large volume of medical claims on daily basis. Consistently keep inventory of over 100 claims at any given moment.
- Researched and resolved complex medical claims issues to support timely processing.
- Paid or denied medical claims based upon established claims processing criteria.
- Evaluated medical claims for accuracy and completeness and researched missing data.
- Assessed medical claims for compliance with regulations and corrected discrepancies.
- Reviewed provider coding information to report services and verify correctness.
- Maintained confidentiality of patient finances, records, and health statuses.
Claims Generalist Associate
Progressive Insurance Company
08.2018 - 09.2021
- Worked productively in fast-moving work environment to process large volumes of claims.
- Analyzed and addressed escalated claims to resolve issues quickly.
- Managed on average 50p customer calls per day.
- Investigate and accurately determine liability and coverage.
- Followed up with customers on unresolved issues.
- Investigate and analyze claims to resolve coverage investigations and make accurate liability decisions.
- Risk Assessment and Mitigation
- Negotiate total loss settlements with first and third party owners as well as finance companies in accordance with policy provisions and state regulations to ensure each claim is being handled properly and in good faith.
- Developed in-depth understanding of insurance policies and procedures to give accurate recommendations to suit clients' needs.
- Investigated accidents or incidents to determine cause and extent of damages.
- Negotiated claim settlements with claimants and attorneys to resolve claims efficiently and fairly.
Casualty Claims Adjuster
Allstate Insurance Company
04.2017 - 08.2018
- Delivered exceptional customer service to policyholders by communicating important information and patiently listening to issues.
- Investigate to determine potential fraud, and ensure that claims are being handled properly to avoid possible suits or compliance and ethics complaints.
- Determine value of third party bodily injury claim. Negotiate medical bills with claimants, attorney's and medical providers in order to settle third party injury claims.
- Examined claims forms and other records to determine insurance coverage.
- Read over insurance policies to ascertain levels of coverage and determine whether claims would receive approvals or denials.
- Reviewed police reports, medical treatment records, and physical property damage to determine extent of liability.
- Reviewed and analyzed suspicious and potentially fraudulent insurance claims.
- Reviewed new files to determine current status of injury claim and to develop plan of action.
- Determined liability outlined in coverage and assessed documentation such from police and healthcare providers to understand damages incurred.
Auto Claims Representative
State Farm Insurance Inc
02.2011 - 04.2017
- Processed and recorded new policies and claims.
- Analyzed claims to determine the extent of the company’s liability, make approval or denial decisions and negotiate settlements
- Interview drivers to determine liability, investigate potential fraud, and settle damage disputes.
- Specialized in coverage investigations, diminished value disputes, arbitration filing and contentions.
- Review, respond, and resolved department of insurance complaints.
- Well versed in NICB and Accurint as well as working closely with SIU for total fire and total theft investigations for 2 years.
- Served as a mentor to new employees and conduct refresher courses for different areas of the auto property department.
Education
No Degree - Business Administration
Frederick Community College
Frederick, MDSkills
- Insurance Calculation
- Outstanding Clerical Abilities
- Electronic Health Records
- Policy Modification and interpretation
- Meticulous Recordkeeping
- Effectively manage multiple duties
- Complaint handling and resolution
- Extensive customer service experience
- Thorough Claims Reviews
- Medical Terminology
- Highly organized and decisive
- Confidential Records Management
- Exceptional interpersonal skills and teamwork
Timeline
Medical Claims Representative
Progressive Insurance Company
09.2021 - Current
Claims Generalist Associate
Progressive Insurance Company
08.2018 - 09.2021
Casualty Claims Adjuster
Allstate Insurance Company
04.2017 - 08.2018
Auto Claims Representative
State Farm Insurance Inc
02.2011 - 04.2017
No Degree - Business Administration
Frederick Community College