Joe Jones
Richmond
Summary
Property Claims Adjuster with extensive expertise in claims investigation, underwriting referrals and subrogation. Skilled in policy interpretation and negotiation to drive cost-effective settlements. Adept in enhancing operational efficiency and customer satisfaction through streamlined processes and meticulous attention to detail. Passionate about applying innovative solutions to improve claims processing and maintain compliance with industry regulations.
Overview
14
14
years of professional experience
1
1
Certification
Work History
Auto Claims Adjuster
Progressive Insurance
2022.01 - Current
- Evaluated auto claims to determine coverage, liability, and damages based on policy terms.
- Collaborated with customers and repair shops to facilitate timely claims resolution.
- Managed complex claims investigations, ensuring compliance with company procedures and regulations.
- Conducted thorough reviews of documentation to uphold quality standards in claims processing.
- Utilized advanced software tools for tracking claim status and generating reports for management review.
- Acted as a reliable point of contact for customers throughout the claims process, addressing their concerns with empathy and professionalism.
- Demonstrated expert knowledge of auto insurance policies and coverages, allowing for accurate assessment of damages and appropriate claim payouts.
- Established an effective system for tracking and monitoring claims from initial report to final resolution, ensuring timely updates were provided to all relevant parties.
- Utilized strong negotiation skills to settle disputed liability cases in a fair and reasonable manner, ultimately minimizing company exposure to financial risk.
- Negotiated with claimants to settle claims.
- Issued payouts to claimants.
- Increased overall efficiency in claims handling by utilizing advanced technology tools for documentation, record-keeping, and data analysis.
- Expedited claim settlements by maintaining open lines of communication with all parties involved, fostering trust, and ensuring a smooth process.
- Mitigated potential litigation risks through careful attention to detail in documenting evidence gathered during investigations and claim evaluations.
- Managed a high volume caseload without sacrificing quality or timeliness in delivering resolutions to clients'' auto accident-related issues.
- Ensured regulatory compliance in all aspects of the auto claims process by staying up-to-date on industry laws and regulations.
- Negotiated fair settlements with both customers and third-party claimants, balancing empathy with fiscal responsibility to protect company assets.
- Examined photographs and surveillance and any other documents relating to claims.
- Coordinated with law enforcement and legal teams to gather necessary documentation for fraud investigations.
- Conducted thorough investigations of auto accidents to accurately determine liability.
- Advocated for customers, ensuring they received fair and prompt settlements for their claims.
- Reviewed police reports, photographs and other documentation to gain complete understanding of accident.
- Coordinated with local body shops to assign repair jobs and obtained rental vehicles for customers for duration of restoration process.
- Identified suspicious claims, escalating issues to supervisor for further investigation and analysis.
- Successfully negotiated settlements with claimants and insurers.
Property Claims Adjuster
American Family Insurance
2020.10 - 2022.01
- Evaluated property damage claims to determine liability and coverage eligibility.
- Collaborated with clients and contractors to facilitate timely claim resolutions.
- Conducted on-site inspections to assess damage and gather evidence for claims.
- Implemented process improvements that enhanced accuracy in claims processing.
- Liaised with legal teams to address complex cases involving potential fraud or disputes
- Enhanced customer satisfaction with prompt communication and consistent follow-up on claim status updates.
- Achieved timely resolution of property claims by investigating, evaluating, and settling a variety of cases.
- Improved overall department performance metrics by consistently meeting or exceeding goals related to cycle time, productivity levels, and customer satisfaction ratings.
- Streamlined the claims process for increased efficiency by consistently updating claim files and maintaining accurate records.
- Managed high caseloads effectively by prioritizing tasks based on complexity and urgency of claims.
- Assisted policyholders with understanding their coverage, providing clear explanations on policy terms and conditions throughout the claims process.
- Collaborated with contractors to verify repair estimates, ensuring fair settlements for both policyholders and company.
Unit Clerk
St. Joseph Medical Center
2015.11 - 2020.10
- Updating boards on each of rooms and verifying nurses’ stations and departments have accurate calendar for day.
- In charge of tube system for any medications being tubed to floor and placing medication room or hand over to appropriate nurse.
- Answering all requests from rooms from call light from patients and/or families and page appropriate nurses or assist with bringing food/supplies to room.
- Admit patients in EPIC and create charts / Also breakdown of charts for discharges Also part of running nurse's station includes calling appropriate people for broken or missing devices, filling out work orders, calling maintenance for anything needing to get fixed on unit.
- Answering all questions from doctors or nurses and assisting with helping staff which could include faxing, fixing copy machine, fax machine, phones or pagers, ordering supplies, paging housekeeping for any cleaning requests in rooms or throughout unit and assisting families walking up to front desk with any questions or concerns.
- Prepared admissions charts and scanned records.
- Coordinated diagnostic tests, collection of samples and transportation to scanning rooms.
- Documented updates to patient information in medical charts while maintaining HIPAA compliance protecting confidentiality of records.
- Obtained and organized medical records for office visits and scheduled labs.
- Assisted with medical coding and billing tasks. ICD 10
- Processed medical insurance claims and payments.
- Registered and verified patient records before triage with most up-to-date information.
- Prepared and processed patient referrals and transfer requests.
Home Healthcare Attendant
Perrylee Home Healthcare Co. Pediatric
2011.08 - 2015.11
- Obtained client medical history, including medication information, symptoms and allergies.
- Assisted with patient transfer and ambulation.
- Maximized patient satisfaction by helping individuals carry out personal tasks such as dressing and walking.
- Gathered dietary information, assisted with feeding and monitored intake to help patients achieve nutritional objectives and support wellness goals.
- Monitored, tracked and conveyed important patient information to healthcare staff to help optimize treatment planning and care delivery.
- Provided total hygiene care for patients by assisting with skincare, bathing and toileting.
- Sanitized and assembled equipment and inserted catheters as directed by nursing staff.
- Assisted patients with therapy exercises as specified by care team, including physical therapy and speech therapy exercises.
- Placed and removed protective devices such as bedside rails and hand restraints to prevent patient injury during treatment.
- Documented vital signs to inform nurses and physicians of any changes in patient status.
- Completed all home cleaning tasks, including dusting, washing dishes, laundry and vacuuming.
- Keep accurate records of patients’ care, condition and progress.
- Scheduled and accompanied clients to medical appointments.
- Used Excel and Word to maintain records of services performed and apparent condition of patients.
Education
Associate of Applied Science - Allied Health
Fortis College
Houston, Tx03.2017
High School Diploma - undefined
John Foster Dulles Sr. High School
Sugar Land, Tx06.2011
Skills
- Customer service, Administrative support, Problem solving, CRM, Medical terminology, Technical support, ICD-9 coding, HIPAA, Policy interpretation, Claims investigation, Damage assessment, Claims processing, Insurance policy, Fraud detection, Insurance regulations, Settlement negotiations, Liability determination, Xactimate, Claims X, Data analysis, Negotiation skills, Team collaboration, Risk assessment, Regulatory compliance, Conflict resolution, Financial analysis, Quality assurance, Project management, Client relations, Workflow optimization, Claims auditing, Insurance underwriting, Compliance monitoring, Risk management, Subrogation
Certification
Texas All Lines Property Adjuster License
Timeline
Auto Claims Adjuster
Progressive Insurance
2022.01 - Current
Property Claims Adjuster
American Family Insurance
2020.10 - 2022.01
Unit Clerk
St. Joseph Medical Center
2015.11 - 2020.10
Home Healthcare Attendant
Perrylee Home Healthcare Co. Pediatric
2011.08 - 2015.11
High School Diploma - undefined
John Foster Dulles Sr. High School
Associate of Applied Science - Allied Health
Fortis College