Kalisha Gray
Aubrey
Summary
Dynamic Sr. Claims Resolution Specialist at Liberty Mutual Insurance with expertise in claims analysis and complex claims management. Proven track record in fraud investigation and enhancing customer relationships, ensuring optimal coverage and payouts. Adept at utilizing Cotality software to streamline processes and mentor junior staff for improved performance.
Overview
21
21
years of professional experience
Work History
Sr. Claims Resolution Specialist I- CAT
Liberty Mutual Insurance
06.2021 - Current
- Handle wind/hail, water, condo, mortgage, fire, theft, and vandalism claims to ensure proper coverage and payout for the claim.
- Review estimate reports provided by field adjuster to make determination of coverage and payout for the claim.
- Assigned an engineer for the claim and reviewed engineer reports to determine coverage.
- Write property estimates using Cotality software.
- Perform desk adjustments for property damage claims on residential homes.
- Manage Additional living expenses on claims and make sure proper coverage and payout is issued.
- Collaborated with clients to gather necessary documentation for claims processing.
- Collaborated with other departments to obtain additional information needed for claim resolution.
- Review property for damage using Cotality.
- Review each policy to determine appropriate coverage and advise policy holders of coverage available within policy and or coverage concerns.
- Handle appraisal requests sent in by insured and counsel for insured.
- Handle public adjuster, attorney claims, and complex claims such as some larger loss claims.
- Investigate potentially fraudulent claims with focus on thoroughness, quality, and cost control.
- Analyzed complex claims to determine eligibility and coverage under policies.
- Mentor junior staff on best practices in claims resolution processes consistently.
- Provide a positive customer experience to the insured by making sure to give an award-winning detailed 1st initial call response to make sure their claim is set up for success.
Customer Inside Auto Claims Specialist
Liberty Mutual Insurance
09.2019 - 06.2021
- Delivered exceptional customer service by ensuring a detailed first call response, setting up claims for successful processing.
- Handling routine auto claims, and liability decisions by gathering information from the customer to make sure we only pay what we owe for the claim.
- Clarified denial and coverage decisions to customers, enhancing their understanding of claims outcomes.
- Assists the customers with understanding the estimates/appraisals for the claim to ensure their vehicle repairs can be completed in a timely manner.
- Collaborated with adjusters to gather necessary documentation for claim processing.
- Drafted statements of loss to summarize damages, payments and underlying policy coverages.
- Communicated effectively with policyholders to explain claims processes and outcomes.
- Evaluated claims for potential fraud and took appropriate actions.
- Assessed property damages and coordinated with repair professionals for estimates.
Customer Service Specialist –Rewrite
Liberty Mutual Insurance
04.2016 - 09.2019
- Educated customers on liability needs and insurance laws to enhance understanding of required coverage.
- Assist policyholders with changes to auto policies such as adding vehicles, removing vehicles, adding operators, and advising policyholders on best coverage fit for their needs.
- Resolved customer issues through effective communication and problem-solving to ensure customer satisfaction.
- Promoted insurance products including home, umbrella, and life policies to expand customer coverage options.
- Conducted thorough reviews of insurance rates to ensure competitive pricing.
- Monitored call center queues daily in order to respond promptly to customer inquiries.
- Assists with rewriting policies due to transfers to new state, divorce/separation, change of ownership of home, and change of ownership of vehicle.
Patient Account Representative Team Lead
Dell
06.2015 - 04.2016
- Answered inbound and made outbound calls to address patient inquiries and issues.
- Verified insurance on accounts for physician office to ensure accurate billing.
- Insurance and self-pay patient billing.
- Resolving account balances with payment plans, and providing financial solutions to underinsured patients.
- Demonstrated knowledge of ICD-9 and ICD-10 coding systems in medical billing processes.
- Trained new hires and fellow employees on systems.
- Researched claims processes and resolved discrepancies for clients to facilitate timely payments.
- Trained new representatives on account management systems and best practices.
Customer service Representative
Pfs Group
02.2015 - 05.2015
- Responded promptly to customer emails and phone calls with professionalism.
- Demonstrated product knowledge to support customers in making informed decisions.
- Managed customer accounts and updated information in the database system.
- Clarified claims processes to clients and researched inquiries.
- Established payment plans and provided financial assistance options for underinsured patients to improve access to care.
- Collaborated with Baylor Scott and White to collect and resolve outstanding patient payments.
- Utilized ICD-9 codes for accurate medical billing.
Participant Service Representative
Hospital accounts –Patient Account Services
01.2014 - 02.2015
- Processed patient and insurance billing transactions accurately and efficiently.
- Answered inbound and outbound calls to address patient inquiries and resolve issues.
- Established payment plans and provided patient discounts to facilitate account payments.
- Insurance and adjustment identification to ensure proper account resolution.
- Training new hires on company policies, medical billing, coding issues, insurance denials, and account adjustments.
- Mentored and coached new hires on company practices and procedures.
Participant Service Representative
Mercer Human Resource Consulting
10.2010 - 06.2013
- Facilitated enrollment process for participants in medical, dental, and health benefits.
- Informed and provided a deeper understanding of benefits for employees and retirees.
- Assisted patients in understanding their insurance coverage and payment options.
- Acted as the primary contact for complex claims and resolutions.
- Assisted with claims processing for providers and employees.
- Coordinated with healthcare providers to ensure accurate billing information.
- Resolved patient inquiries and account discrepancies, enhancing overall service experience.
- Managed call center operations, overseeing large call queues and delivering chat support.
- Reached out to health carriers to gather information for employees.
Response Specialist
Atx Technologies
01.2006 - 08.2010
- Handled inbound calls for higher-end vehicles, ensuring customer needs were met with high-quality service.
- Delivered technical support for customers, effectively resolving complex issues to enhance user experience.
- Acted as escalation point for incidents involving accidents and vehicle thefts, facilitating timely resolutions and customer satisfaction.
- Analyzed customer feedback to improve service quality and client satisfaction.
- Provided concierge service for customers.
- Assisted in selling packages that better suited customer needs.
- Collaborated with teams to develop effective communication strategies and initiatives.
Dispatcher and Roadside assistance Specialist
Aaa Texas
01.2005 - 01.2006
- Coordinated emergency responses for roadside assistance, ensuring timely support for customers.
- Received and dispatched calls for emergency services.
- Escalation point for customers with vehicle issues.
- Managed effective communication between service providers and customers, facilitating smooth operations.
- Provided comprehensive towing services at a single location.
- Developed enhanced service packages for customers, increasing revenue for the company.
- Maintained logs of all incoming calls and assigned tasks.
- Gathered feedback and produced documentation for upper management.
Education
High school diploma -
Nimitz High School
IRVING, TXProperty and casualty adjuster license -
Texas Department of Insurance
Skills
- Claims analysis
- Complex claims management
- Policy interpretation
- Fraud investigation
- Risk assessment
- Cotality software
- Customer relationship management
References
Shay Houston, Claims Specialist-Property Complex, Shay.Houston6i4@statefarm.com
Leadership Experience
I have worked training fellow employees, and new hires. Training, and working as a team lead has been a very rewarding experience. I have also worked in a mentor program helping fellow employees who may need extra assistance, or questions related to on-the-job training.
Timeline
Sr. Claims Resolution Specialist I- CAT
Liberty Mutual Insurance
06.2021 - Current
Customer Inside Auto Claims Specialist
Liberty Mutual Insurance
09.2019 - 06.2021
Customer Service Specialist –Rewrite
Liberty Mutual Insurance
04.2016 - 09.2019
Patient Account Representative Team Lead
Dell
06.2015 - 04.2016
Customer service Representative
Pfs Group
02.2015 - 05.2015
Participant Service Representative
Hospital accounts –Patient Account Services
01.2014 - 02.2015
Participant Service Representative
Mercer Human Resource Consulting
10.2010 - 06.2013
Response Specialist
Atx Technologies
01.2006 - 08.2010
Dispatcher and Roadside assistance Specialist
Aaa Texas
01.2005 - 01.2006
High school diploma -
Nimitz High School
Property and casualty adjuster license -
Texas Department of Insurance