Summary
Overview
Work History
Skills
Certification
Timeline
Generic

Kelliann Kimber

Olympia,WA

Summary

Analytical Claims Specialist with proven experience investigating and resolving property, health and business claims. Delivers professional and balanced customer service and meets needs of insured, claimant and internal and external customers. Insurance expert with exceptional knowledge of legal liabilities and claims practices and superior interpersonal skills.

Overview

31
31
years of professional experience
1
1
Certification

Work History

Bodily Injury Claims Specialist

State Farm
DuPont, WA
01.2021 - Current
  • Investigated bodily injury claims and determined coverage eligibility.
  • Assessed medical records, witness statements, and police reports to evaluate liability.
  • Negotiated settlements with claimants and attorneys.
  • Resolved complex bodily injury cases involving multiple parties.
  • Reviewed insurance policies for applicable coverage limits and exclusions.
  • Prepared detailed documentation outlining claim decisions, actions taken, and rationale for settlement amounts.
  • Provided timely updates to policyholders regarding their claim status.
  • Conducted research on legal precedents related to bodily injury claims handling.
  • Maintained accurate records of all claim files, including documents related to claim resolution activities.
  • Advised management on strategies for mitigating losses associated with bodily injuries.
  • Collaborated with outside vendors such as adjusters, investigators, and lawyers throughout the claims process.
  • Monitored performance metrics such as average duration of a claim resolution or total incurred loss amount per case.
  • Participated in regular meetings with senior leadership to discuss progress towards departmental goals.
  • Ensured compliance with state laws governing the handling of personal injury cases.
  • Provided guidance and support to junior staff members when needed during difficult cases.
  • Drafted correspondence between insurers and claimants about settlement offers or other matters related to the case.
  • Maintained knowledge of policies and procedures and insurance coverage benefit levels, eligibility systems and verification processes.
  • Resolved claims by approving or denying documentation, calculating benefits due and determining compensation settlement.
  • Planned and conducted investigations of claims to confirm coverage and compensability.
  • Assessed and conducted negotiations within authority limits to settle claims.
  • Provided legal support by assembling documentation for settlement action.
  • Contacted injured parties and legal representatives to negotiate final settlements for claims.

Total Loss Claims Adjuster

State Farm
DuPont, WA
02.2017 - 10.2021
  • Monitored industry trends related to total loss processes and best practices.
  • Collaborated with other departments within the organization in order to resolve customer issues quickly and efficiently.
  • Approved rental car reimbursement requests in accordance with company guidelines.
  • Performed detailed research into complex cases in order to make informed decisions regarding liability and damages.
  • Adhered to established procedures for handling sensitive information securely.
  • Communicated effectively with clients via telephone, email, or written correspondence.
  • Prepared detailed reports outlining findings from investigations.
  • Assessed salvage values for totaled vehicles in order to calculate settlement amounts.
  • Analyzed vehicle history reports to determine if a total loss was warranted.
  • Negotiated settlements with repair shops and claimants.
  • Provided timely updates to customers regarding the status of their claims files.
  • Reviewed repair estimates to ensure accuracy and completeness.
  • Investigated, documented and processed total loss claims for automobile and property damage.
  • Determined the appropriate course of action for each claim based on insurance policy coverage.
  • Advised customers of repair plans, discussing payment options to finalize work orders.
  • Determined salvage value for total-loss vehicles.
  • Evaluated claims for possible fraud, contacting appropriate department for assistance and further investigation.

Independent Insurance Agent

Self-employeed
10.2013 - 02.2017
  • Offered MAPD, MA, PDP, Medicare Supplement, Life and Disability plans through several insurance companies in Oregon, Arkansas and Washington State
  • Navigation of multiple applications switching between screens with two monitors to do so
  • Qulity assurance was maintained by monitoring phone calls and being scored on my different categories
  • HIPAA compliance, knowledge of benefits and materials, empathy and over all customer service
  • Provided personalized service to customers to determine their specific insurance needs.

Billing and Consulting- Owner

NW Billing
09.2006 - 02.2017
  • NW Billing is a Medical billing company; as of October of 2009 I handle only provider’s AR claims over 180 days older on a per contract basis
  • As well as train an offices staff on billing practices, common mistakes, calling insurance companies (to have claims reprocessed) and filing appeals
  • Also provide credentialing services to providers and advise providers on contracting and understanding their provider contracts with insurance companies
  • Previously I had obtained several contracts all over Washington State with a variety of provider specialties and handle all aspects of the insurance business which included medical billing with the highest level of efficiency using Healthwind/Horizon Billing Program
  • Negotiated contracts with vendors and suppliers.

Insurance Agent

BroadPath Healthcare
09.2015 - 01.2016
  • Explanation and sales via incoming calls for Arkansas Blue Cross and Blue Shield's MA, MAPD, PDP, Medicare Supplement and Individual plans on and off exchange so that beneficiaries and individuals can make an informed decision.
  • Maintained 100% through a series of 25 or more phone calls that were monitored.

BroadPath Healthcare Solutions-Producer

09.2014 - 02.2015
  • Explanation and sales via incoming calls for Providence Health's MA, MAPD, PDP, Medicare Supplement and Individual plans off exchange so that beneficiaries and individuals could make an informed decision in Oregon and Washington State.

Sterling Health Plans-Producer

08.2011 - 10.2013
  • Explanation and sales of Sterling Health MAPD, MA, PDP, Medicare Supplement plans, life and disability plans so that beneficiaries can make an informed decision.

Westcare Clinic- Billing Manager/Insurance Specialist

08.2008 - 03.2011
  • In addition to being a large urgent care clinic, Westcare also managed a large clientele of workman’s compensation patients and also held several contracts with local business for employment drug screening
  • While employed, I was in accountable for maintaining, training, advising and implementing medical billing procedures on Healthwind appointment scheduling/billing software, QuickBooks and reporting any and all data analysis obtained utilizing Microsoft Excel Spreadsheets
  • I proficiently managed and reported all aspects of electronically billing healthcare claims resulting in a successful urgent care clinic
  • I compiled, analyzed and reconciled AR and AP for month, quarter and year end reporting, conducting audits on coding position for quality assurance, financial analysis and statistic reporting, as well as calculating and reporting collections accounts; then submitting customized claim and financial analysis utilizing Microsoft Excel spreadsheets for productivity reporting
  • I also addressed and successfully achieved conflict resolution during patient and employee complaints and issues
  • Resolved EDI and Insurance claims edits and denials; verbally and written
  • My responsibilities also included providing quick and accurate financial data for adjustments and refunds to patients and insurance companies
  • I was the administrator for provider accessed insurance websites and for the in office’s business programs; providing and maintain access for staff and doctors
  • I was entrusted to provide the most updated information and answered questions of administration staff and doctors at any time I was needed, including while outside the office
  • I solely established and Maintain Provider One/State Medicaid website for Westcare, in addition to keeping providers contracts with insurance companies current and credentialing newly hired clinicians
  • I am a patient advocate, as I will always go above and beyond for any patient with insurance questions and concerns
  • As well, Westcare did not have in house IT support, support came in about two times a month, because of this, trouble shooting IT problems were handled mostly by me as I fixed and maintained the office network connection, as problems the arose more than the two times per month IT’s scheduled appointments would arrive; along with individual employee computer work station failures and issues
  • As a result of my accurate audits and analysis of claim coding, entry and documentation I was able to create a more efficient procedure for clean claim submission I also implemented, tested, and trained on the Provider One claims program through DSHS for Westcare, without any major issues or delay in payment and was applauded in the Daily Olympian on this accomplishment.

Northwest Center for Natural Medicine- Office Manager

09.2003 - 10.2006
  • I was in authority for maintaining, advising and implementing procedures on Healthwind appointment scheduling/billing software and QuickBooks
  • Computed, analyzed and balanced daily, monthly and yearly AR/AP
  • I was accountable for educating and training each receptionist on supplement mixology processing patients, day end back-ups and balancing, referrals, ordering supplies and supplements for dispensary
  • Utilized and maintained Horizons program for medical billing and Quick Books for supplements
  • Day end balancing, month end balancing, and year end balancing
  • Training receptionist on supplements and checking in and out patients, day end back-ups, referrals, order supplies and how to use Healthwind appointment scheduling software
  • Other management duties included ordering supplements, research supplements and herbal remedies, price, shelved and sold supplements and herbs, inventory of supplements and herbs, answer basic questions about supplements and herbs to patients and how to use them
  • I would also consult in herb and supplement books for contraindications with other medications, and was entrusted with make tinctures for patients
  • An expert in all aspects of medical billing for five dual licensed physicians, I worked with Premera to update their dual license procedures and claim payment.

Group Health Cooperative -Claims Auditor

11.2001 - 11.2002
  • Auditing, analysis and correcting procedures of entry of claims, claims payment and edit resolution for all lines of business
  • Conduct program audits and processor audits for quality assurance.

Provider Services-Capitation Coordinator/Adjustments & Refunds/Claims Adj. III

12.1998 - 11.2001
  • Responsible for running day to day provider payments, printing statements of remittances and checks to send to providers
  • Coordinate and establish each month capitation and fund pools with a reconciliation process
  • Other duties included provider capitation accounts, refunds and adjustments and void checks, auditing and training others on adjustments and refunds
  • Created accounting spread sheets/ledgers, and reconciliation spread sheets
  • A/R A/P and credit balance accounts
  • I processed claims at a senior adjudicator level with knowledge of ICD-9, HCPC, CPT, REV and DRG codes
  • Utilized contracts, fee schedules and preformed adjustments, refunds and COB
  • As well, I established procedure for adjustments and refunds and training of newly hired adjudicators and adjustment and refund specialists
  • Promoted to Capitation Coordinator in a short time at Provider Services because of successful claims processing, ability to detect software issues in claim auto pay, successful training of employee's and always giving 110%

Office of the Insurance Commissioner-Claims Analyst

09.1998 - 12.1998
  • Responsible for examining claims that came in from providers to Unified Physicians as they were going out of business and auditing staff work to maintain quality assurance, corrected incorrectly priced claims and benefits errors.

Cascade Billing Services- Office Manager/Billing Rep

11.1995 - 09.1998
  • I joined Cascade Billing Service crew as a Billing Rep and was promoted to Office Manager a short time later
  • I then was relied on for hiring and training of new employees, resolving employee questions
  • I was committed to resolving personnel and client account issues
  • I also successfully achieved all daily business details such as end of day computer back-ups, end of day business and doctor reports, electronic transmitting of insurance companies and printing of all paper claims while continuing to provide excellent billing services to accounts previously handled prior to promotion
  • Promoted to Office Manager in a short time at Cascade Billing because of successful determination/resolution of denied claims and a very low percentage of claims being over 30 and 60 days old and my strong ability to trouble shoot.

Department of Labor & Industries- Claims/Data Entry

09.1993 - 11.1995
  • MIPS claim payment system for the State of Washington, initiated injured worker claims in system set for adjudication.

Skills

  • Settlement Negotiation
  • Litigation Management
  • Policy Interpretation
  • Injury evaluation
  • Damage estimation
  • Claims Investigation
  • Coverage assessments
  • Documentation Review
  • Settlement determinations
  • Accident Investigations
  • Insurance knowledge
  • Verbal Communication
  • Claims Processing
  • Eligibility Determination
  • Claim Amount Calculations
  • Client Interviews
  • Interpersonal Communication
  • Information Verification
  • Electronic authorization processing
  • Policy analysis
  • Task Prioritization
  • Background in insurance
  • Written Communication
  • Composing Business Correspondence
  • Problem-Solving
  • Critical Thinking
  • Insurance terminology
  • Coverage Determination
  • Payment and Investigation Escalations
  • Analytical Skills
  • Medicaid knowledge
  • Team Collaboration

Certification

  • Licenced Claim Adjuster in FL, LA, GA, TX

Timeline

Bodily Injury Claims Specialist

State Farm
01.2021 - Current

Total Loss Claims Adjuster

State Farm
02.2017 - 10.2021

Insurance Agent

BroadPath Healthcare
09.2015 - 01.2016

BroadPath Healthcare Solutions-Producer

09.2014 - 02.2015

Independent Insurance Agent

Self-employeed
10.2013 - 02.2017

Sterling Health Plans-Producer

08.2011 - 10.2013

Westcare Clinic- Billing Manager/Insurance Specialist

08.2008 - 03.2011

Billing and Consulting- Owner

NW Billing
09.2006 - 02.2017

Northwest Center for Natural Medicine- Office Manager

09.2003 - 10.2006

Group Health Cooperative -Claims Auditor

11.2001 - 11.2002

Provider Services-Capitation Coordinator/Adjustments & Refunds/Claims Adj. III

12.1998 - 11.2001

Office of the Insurance Commissioner-Claims Analyst

09.1998 - 12.1998

Cascade Billing Services- Office Manager/Billing Rep

11.1995 - 09.1998

Department of Labor & Industries- Claims/Data Entry

09.1993 - 11.1995
  • Licenced Claim Adjuster in FL, LA, GA, TX
Kelliann Kimber