Jocylynn Jackson

• Support first notice of loss by gathering accident details including date of loss, vehicle information, parties involved, location, and preliminary loss facts.
• Review policy coverage, deductibles, liability limits, collision, comprehensive, rental reimbursement, and roadside assistance to explain available benefits to policyholders.
• Document claim-related conversations, customer statements, account notes, and supporting details accurately within internal systems.
• Assist customers with claim reporting procedures, required documentation, repair process questions, and next-step expectations after an accident.
• Coordinate with claims representatives, internal departments, repair facilities, and customers to help move claim activity forward.
• Maintain strong attention to detail while handling multiple customer contacts, documentation requirements, and follow-up tasks in a fast-paced environment.
• Deliver prompt, professional service while de-escalating customer concerns and resolving claim-related questions with accuracy.

• Proactively identifies and reports claim payment discrepancies, including overpayments and underpayments, helping to reduce financial risk and support accurate claims resolution.
• Conducts in-depth review of complex and high-dollar claims beyond standard adjudication levels, ensuring correct processing, benefit interpretation, and adherence to compliance standards.
• Utilized computers and computer systems (including hardware and software) to program, write software, set up functions, enter data or process information

Performs claim rework calculations to correct payment discrepancies and ensure accurate benefit determination

• Applies medical guidelines to determine coverage, complete eligibility verification, identifies discrepancies, and applies all cost containment measure to complete the adjudication process.

• Accurately document detailed benefit information, including cost-share responsibilities (deductibles, co-pays, coinsurance) and provider access options to support care coordination.
• Collect and review all required patient insurance details to ensure complete and accurate benefit verification, minimizing delays in the treatment process.
• Identify prior authorization requirements, coverage restrictions, and potential barriers to treatment; collaborate with stakeholders to expedite patient access to care.
• Verify patients’ insurance eligibility, coverage limits, and benefit details by coordinating directly with insurance carriers and healthcare providers.