Juanita Young
Mansfield,TX
Summary
Organized and detail-oriented Investigator dedicated to improving efficiency, productivity and profitability through continuous process improvement. Analytical thinker skilled at developing innovative solutions to complex problems.
Overview
10
10
years of professional experience
Work History
Claims Adjuster
Baptist Memorial Hospital Memphis
12.2020 - Current
- Examined claims forms and other records to determine insurance coverage.
- Reviewed police reports, medical treatment records, and physical property damage to determine extent of liability.
- Prepared summaries of damage, payments, and policy coverage.
- Researched and analyzed policy contracts to verify proper payment of claims.
- Evaluated insurance policies and analyzed damages to determine coverage.
- Conducted comprehensive interviews of witnesses and claimants to gather facts and information.
- Established relationships with clients and insurance companies to foster timely claims resolution.
Claims Benefit Specialist
Blue Cross Blue Shield Of TN
06.2017 - 09.2020
- Enhanced claim processing efficiency by streamlining workflows and implementing best practices.
- Resolved complex claims issues for improved customer satisfaction and reduced claim backlog.
- Decreased turnaround time for claim approvals with thorough investigation and efficient documentation.
- Facilitated communication between departments, ensuring timely resolution of outstanding claims.
- Managed high-volume caseloads, consistently meeting deadlines and maintaining accuracy in claim review.
- Collaborated with medical professionals to obtain accurate information for proper benefit determination.
- Negotiated settlements on disputed claims, resulting in equitable resolutions for all parties involved.
- Conducted comprehensive audits to identify areas of improvement within the claims process, leading to a more efficient system.
Claims Representative
USAA Insurance
05.2014 - 09.2017
- Analyzed and addressed escalated claims to resolve issues quickly.
- Worked productively in fast-moving work environment to process large volumes of claims.
- Researched and analyzed complex claims to determine next steps and possible outcomes.
- Updated claims system to track claim status and provide relevant information to other department.
- Developed in-depth understanding of insurance policies and procedures to give accurate recommendations to suit clients' needs.
- Followed up with customers on unresolved issues.
- Collaborated with internal departments and external vendors to achieve fast resolution of claims.
Education
Associate of Science - Information Technology
University Of Phoneix
Phoenix, AZ09.2018
Skills
- Automobile Claims Specialist
- Familiar With Fraud Statutes
- Legal Proceedings Knowledge
- Underwriting Knowledge
- Claims Processing
- Insurance Policy Coverage Knowledge
Timeline
Claims Adjuster
Baptist Memorial Hospital Memphis
12.2020 - Current
Claims Benefit Specialist
Blue Cross Blue Shield Of TN
06.2017 - 09.2020
Claims Representative
USAA Insurance
05.2014 - 09.2017
Associate of Science - Information Technology
University Of Phoneix