Kevin Wilson
Austin,TX
Summary
Medical claims adjuster with over two years of experience handing high-volume auto claims and identifying inconsistence in medical documentation and billing. Skilled in claim investigation, recorded statements, and claim analysis. Possess a background in emergency medical services with strong clinical insight, critical thinking, and phlebotomy in high pressure encounters.
Overview
6
6
years of professional experience
1
1
Certification
Work History
Medical Claims Adjuster
Progressive Auto Insurance
Remote
02.2024 - Current
- Manage a high volume caseload of 300+ medical claims, evaluating coverage and billing accuracy
- Analyze medical records, treatment plans, and billing statement to identify inconsistencies and potential fraud indicators
- Conduct recorded statements with claimants, providers, and attorneys to verify claim details
- Identify red flags such as excessive treatment, billing irregularities, and questionable injury patterns
- Analyzed policy details along with supporting documents provided by healthcare providers to make informed decisions on claims approvals or denials.
Senior Customer Service Representative
Progressive Auto Insurance
Remote
07.2022 - 02.2024
- Handled complex customer inquiries related to auto policies and claims with a focus on resolution and accuracy
- Investigated and resolved escalated issues requiring critical thinking and problem solving while utilizing a strong command of company guidelines and policies
- Maintained high performance metrics in a fast-paced, high call-volume environment
- Trained and mentored new hires on core processes and foundational knowledge
- Established strong rapport with customers, fostering long-term relationships and repeat business.
Emergency Services Technician
St. Dominic's Hospital
Jackson, MS
05.2020 - 07.2022
- Assisted medical staff in a high-paced emergency room environment
- Collected patient information and supported clinical documentation
- Collaborated with physicians and nurses to support patient consultations and ensure accurate transfer of information
- Performed phlebotomy duties, such as the drawing of blood and the labeling of tubes and cultures for laboratory processing
- Measured vital statistics, collected specimens for lab analysis and recorded data in appropriate medical records.
Education
Bachelor of Science - Biology
University of Southern Mississippi
Hattiesburg, MS05-2020
Skills
- Critical thinking
- Customer service
- Data entry
- Specimen handling
- Patient care
- Medical claims
Certification
Claim adjusting licensing
Timeline
Medical Claims Adjuster
Progressive Auto Insurance
02.2024 - Current
Senior Customer Service Representative
Progressive Auto Insurance
07.2022 - 02.2024
Emergency Services Technician
St. Dominic's Hospital
05.2020 - 07.2022
Bachelor of Science - Biology
University of Southern Mississippi