Summary
Overview
Work History
Education
Skills
Additional Information
Certification
Timeline
Generic

Joquelle Jones

Carbon

Summary

Comprehensive Property Claims Adjuster with outstanding customer service skills. In-depth experience completing assigned claims promptly and accurately. Analytical and innovative with first-rate problem-solving abilities. Skilled in Xactimate and Claims X. Experience in settling claims with contractors and policy holders.

Overview

13
13
years of professional experience
1
1
Certification

Work History

Property Claims Adjuster

American Family Insurance
03.2023 - Current
  • Achieved timely resolution of property claims by investigating, evaluating, and settling a variety of cases.
  • Streamlined the claims process for increased efficiency by consistently updating claim files and maintaining accurate records.
  • Enhanced customer satisfaction with prompt communication and consistent follow-up on claim status updates.
  • Reduced company expenses by accurately determining coverage and negotiating cost-effective settlements with policyholders.
  • Collaborated with contractors to verify repair estimates, ensuring fair settlements for both policyholders and company.
  • Conducted thorough inspections to document property damages, resulting in accurate claim evaluations.
  • Maintained compliance with state regulations and company guidelines through diligent adherence to policies and procedures.
  • Used Xactimate to compile estimates for personal property and structure damage.
  • Scoped and photographed properties for defects and damage.
  • Prepared sketch of floor plan and roofline and entered data into Xactimate to develop line-by-line item costs of damages.
  • Identified suspicious losses and contacted manager for investigative assistance.
  • Assisted homeowners by coordinating vendor services, emergency repair, cleaning and contractors.

Claims Representative

Blue Cross Blue Shield Of Texas
10.2020 - 02.2023
  • Improved claim processing efficiency by streamlining workflows and implementing best practices.
  • Reduced errors in claims submissions through meticulous attention to detail and thorough review processes.
  • Expedited claim resolution times with proactive communication between patients, providers, and insurance companies.
  • Maintained accurate patient records by diligently updating databases and following strict documentation guidelines.
  • Collaborated with interdisciplinary teams to ensure smooth processing and accurate reimbursement of medical claims.
  • Managed high volume of claims, consistently meeting deadlines without compromising accuracy or quality.
  • Enhanced team productivity by providing training sessions on claim processing software and regulatory updates.
  • Conducted regular audits of processed claims to identify areas for improvement and potential fraud risks.
  • Assisted in the development of policies and procedures related to medical claims management, ensuring compliance with industry regulations.
  • Optimized workflow processes by identifying bottlenecks within the system, implementing necessary changes for increased efficiency.
  • Effectively resolved claim disputes by conducting thorough investigations and presenting findings to stakeholders clearly and concisely.
  • Monitored outstanding accounts receivable balances for trends that could indicate payer issues or potential collection problems.
  • Utilized advanced knowledge of ICD-10 codes to accurately process complex medical claims.
  • Identified opportunities for cost savings by analyzing medical billing patterns across various departments.
  • Educated staff members on proper coding techniques through comprehensive training seminars.
  • Skillfully navigated Medicare/Medicaid regulations in order to secure maximum reimbursement rates for qualifying services provided.
  • Verified patient insurance coverage and benefits for medical claims.
  • Managed large volume of medical claims on daily basis.
  • Evaluated medical claims for accuracy and completeness and researched missing data.
  • Responded to correspondence from insurance companies.
  • Monitored and updated claims status in claims processing system.
  • Maintained knowledge of benefits claim processing, claims principles, medical terminology, and procedures and HIPAA regulations.
  • Followed up on denied claims to verify timely patient payment and resolution.

UNIT CLERK

St. Joseph Medical Center
11.2015 - 10.2020
  • Updating boards on each of rooms and verifying nurses' stations and departments have accurate calendar for day.
  • Collect all phones and pagers and get them set up with new batteries and assign them to appropriate nurse.
  • 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.

HOME HEALTHCARE ATTENDANT

Perrylee Home Healthcare Co. Pediatric
08.2011 - 11.2015
  • 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, Tx
03.2017

High School Diploma -

John Foster Dulles Sr. High School
Sugar Land, Tx
06.2011

Skills

  • Customer service and care
  • Adherence to high customer service standards
  • Customer service support
  • Customer needs anticipation and conflict mitigation
  • Complaint resolution
  • Report preparation
  • Administrative support
  • Creative problem solving
  • CRM
  • Medical terminology knowledge
  • Technical Support
  • ICD-9 coding
  • HIPPA acknowledgement
  • Policy Interpretation
  • Claims Investigation
  • Damage Assessment
  • Claims Processing
  • Analytical-Minded
  • Insurance Policy Knowledge
  • Fraud Detection
  • Insurance Regulations
  • Property Damage Assessment
  • Settlement Negotiations
  • Casualty and Property Loss
  • Liability Determination

Additional Information

  • Team-oriented medical professional accustomed to streamlining shipping and receivingprocesses to increase overall efficiency. Industrious and dedicated with talents incustomer service and medical supply chain . Energetic individuals equipped to workhard in fast-paced, constantly changing environments.Astute Front Office Receptionist with experience managing data and controllingrecordkeeping. Expert at optimizing processes to improve data retrieval and storageprocedures, reduce physical storage needs and maintain security of information. Skilledat researching and resolving discrepancies.Outgoing and friendly receptionist delivering customer service and administrativeexcellence, including clerical support and public interaction. Excels in calendarmanagement, scheduling, data-entry and database administration.Well-qualified Pediatric home healthcare worker skilled in delivering top-quality homecare support. Effective at ambulating patients, meeting personal grooming needs andadministering medications. Detail-oriented in maintaining clean and organized personalareas to support daily living safety.

Certification

Texas All Lines Property Adjuster License

Timeline

Property Claims Adjuster

American Family Insurance
03.2023 - Current

Claims Representative

Blue Cross Blue Shield Of Texas
10.2020 - 02.2023

UNIT CLERK

St. Joseph Medical Center
11.2015 - 10.2020

HOME HEALTHCARE ATTENDANT

Perrylee Home Healthcare Co. Pediatric
08.2011 - 11.2015

Associate of Applied Science - Allied Health

Fortis College

High School Diploma -

John Foster Dulles Sr. High School

Similar Profiles

CREATE PROFILE
Joquelle Jones