Kimberly Watson
Spring,Tx
Summary
Diligent [independent Adjuster] with solid background in property claims adjustment. Effectively managed complex claims and facilitated fair settlements. Demonstrated proficiency in detailed investigation and negotiation skills.
Professional property claims specialist prepared to exceed expectations in evaluating and resolving claims. Adept at navigating complex cases and ensuring equitable resolutions. Valued for collaborative approach and adaptability to shifting priorities, leveraging keen analytical and problem-solving abilities.
Experienced with assessing property damage and determining claim validity. Utilizes comprehensive analytical skills to ensure accurate and fair claim resolutions. Track record of effective communication and negotiation with stakeholders.
Seasoned Auto Claims Adjuster with a [Number]-year background in preparing insurance claims for vehicle damages. Superb knowledge of resolution and claim settlement procedures. Familiarity with general liability procedures and auto insurance policies.
Appraiser adept at completing high volume of appraisals quickly and accurately. Motivated to exceed business expectations while delivering highly accurate results. Proven history of streamlining processes for maximized productivity.
Overview
11
11
years of professional experience
1
1
Certification
Work History
Prior Authorization Specialist
Cigna
11.2023 - Current
- Collaborated with physicians to obtain necessary clinical information for prior authorization submissions.
- Verified eligibility and compliance with authorization requirements for service providers.
- Analyzed medical records and other documents to determine approval of requests for authorization.
- Responded to inquiries from healthcare providers regarding prior authorization requests.
- Evaluated clinical criteria for approval or denial of services requiring pre-authorization.
- Reduced turnaround time for prior authorization requests by utilizing electronic submission methods.
- Coordinated with billing department to resolve discrepancies related to denied claims due to incomplete or incorrect prior authorizations.
- Maintained thorough knowledge of insurance plan requirements, facilitating accurate and timely completion of authorization forms.
- Input all patient data regarding claims and prior authorizations into system accurately.
- Managed a high volume of incoming calls, maintaining professionalism while effectively addressing the needs of callers seeking assistance with prior authorizations.
Prior Authorization Representative
Prime Therapeutics LLC
09.2021 - 09.2024
- Verified eligibility and compliance with authorization requirements for service providers.
- Ensured compliance with HIPAA regulations by maintaining strict confidentiality in handling sensitive patient information.
- Processed new medication and refill requests for authorization.
- Communicated pertinent information to client's prescribing provider to facilitate quality service.
- Improved patient satisfaction by efficiently processing prior authorization requests and ensuring timely responses.
- Reduced claim denials by thoroughly reviewing and analyzing medical necessity documentation before submitting for approval, ensuring all criteria were met.
- Streamlined workflow for faster approval turnaround times, handling high volume of insurance verification tasks.
- Collaborated with healthcare providers to expedite the process of obtaining necessary medical documentation for approvals.
- Fielded telephone inquiries on authorization details from plan members and medical staff.
Tax Preparer
Intuit
03.2020 - 04.2023
- Advised clients to comply with IRS regulations and meet state and federal tax obligations.
- Finalized and processed paperwork with local, state and federal government authorities.
- Supplied detailed tax documentation needed to submit accurate corporate and individual returns.
- Prepared estimated and deferred tax calculations on monthly basis to forecast cash flows.
- Used tax form instructions and tables to complete tax forms.
- Interviewed clients to obtain additional information on taxable income and deductible expenses and allowances.
- Maintained high levels of confidentiality when dealing with sensitive client information, fostering trust and loyalty among clients.
- Analyzed financial records to verify accuracy of tax returns.
Customer Service Sales Specialist
Asurion Insurance Services
04.2018 - 02.2020
- Delivered superior customer service to retain existing customers and attract future customers.
- Informed customers of sales and promotions to build customer base, boost traffic and increase customer loyalty.
- Determined customer needs and interests to recommend cell phone insurance coverage to customers.
Flood Adjuster
Correct Claim Public Adjusters, LLC
02.2014 - 07.2018
- Negotiated settlements between policyholders and insurance carriers, ensuring fair outcomes for both parties involved.
- Maintained open lines of communication with clients throughout the entire claims process to address concerns promptly and compassionately.
- Expedited claim resolution by swiftly responding to catastrophe events and efficiently managing a high caseload of claims.
- Conducted thorough research on industry trends to stay current with changes in flood adjustment regulations and procedures.
- Facilitated a smoother transition back into normal life for clients by providing clear explanations of available assistance programs related to their specific circumstances.
Education
Associate of Science - Cyber Security
Lonestar Community College
06.2025
Certificate - Flood Adjuster
Fema
Texas04-2025
Certificate -
All Adjuster
Houston, TX08-2022
Certificate - Real Estate
Champion School of Realtor
Houston, TX03.2022
Associate of Arts - Hospitality Administration And Management
Houston Community College
07.2013
Skills
- Liability Determinations
- Rules of Evidence
- Claim Validity Determination
- Property Adjusting
- Insurance Policy Coverage Knowledge
- Claims Evaluations
- Property Claims
- Healthcare Industry Knowledge
- Retro-Authorizations
- Patient Scheduling
- Insurance Verification
- Client Service
- Follow-up skills
- Insurance verification
- Effective communication skills
- Damage assessment
- Property inspection
- Claims investigation
Certification
- Flood adjuster, Fema -
- all adjuster license
- Notary license
- Real estate Certification
Timeline
Prior Authorization Specialist
Cigna
11.2023 - Current
Prior Authorization Representative
Prime Therapeutics LLC
09.2021 - 09.2024
Tax Preparer
Intuit
03.2020 - 04.2023
Customer Service Sales Specialist
Asurion Insurance Services
04.2018 - 02.2020
Flood Adjuster
Correct Claim Public Adjusters, LLC
02.2014 - 07.2018
Associate of Arts - Hospitality Administration And Management
Houston Community College
Associate of Science - Cyber Security
Lonestar Community College
Certificate - Flood Adjuster
Fema
Certificate -
All Adjuster
Certificate - Real Estate
Champion School of Realtor
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