Kristina Fordham
Atlanta,GA
Summary
Efficient and productive Claims Specialist known for swiftly and accurately managing claims processes. Specialize in policy interpretation, negotiation, and settlement strategies which streamline operations and improve turnaround times. Possess strong analytical skills, fraud detection capabilities, and knowledge of insurance regulations. Excel in communication, problem-solving, and organizational skills to effectively handle multiple claims simultaneously while maintaining high satisfaction levels among all parties involved.
Overview
7
7
years of professional experience
Work History
Claims Specialist -Injury
State Farm
09.2021 - Current
- Investigated, evaluated, negotiated, and settled claims for assigned area using various communication methods.
- Managed organized daily schedule to handle phone calls and task-driven queues effectively.
- Interpreted legal documents related to claims processing, including contracts and policy language.
- Conducted in-depth investigations of complex or high-value claims to uncover discrepancies and fraud indicators.
- Applied knowledge of policies, procedures, laws, statutes, and insurance regulations to determine coverage and liability.
- Utilized strong verbal communication skills to resolve conflicts while maintaining professionalism.
- Fostered meaningful relationships with customers throughout claims handling process.
- Collaborated with team members and business partners to enhance customer service experience.
Owner/Founder
Nina Ellis & Co. Events, LLC
08.2021 - Current
- Conceptualized and executed intimate events for diverse occasions.
- Coordinated event design and décor, serving as on-site coordinator.
- Oversaw all aspects of event planning, including site selection and vendor negotiation.
- Conducted post-event evaluations to improve future events.
- Developed and implemented planning agendas using Excel for effective communication.
- Collaborated with clients to negotiate agreements and manage event logistics.
- Maintained comprehensive financial records for budget tracking and reconciliation.
- Cultivated strong relationships with clients, vendors, and sponsors to drive repeat business.
Plan Change/Operations Lead
Aliera Companies/Tatic Edge Solutions, LLC
01.2018 - 08.2021
- Managed high-volume inbound calls, resolving all billing inquiries and invoicing issues.
- Reviewed medical records to assess necessity of requested plan changes.
- Participated in cohort meetings to develop training materials.
- Provided exceptional customer service by promptly addressing internal and external requests.
- Verified billing data, correcting errors for accurate recording and entry.
- Collaboratively secured documentation to meet company standards.
- Conducted investigations utilizing internal resources and documentation processes.
- Administered accounts payable invoices, reflecting necessary direct and indirect charge changes.
Education
Master of Business Administration - Marketing
Strayer University
Augusta, GA01.2017
Bachelor of Arts - Mass Communications & Public Relations
Paine College
Augusta, GA01.2009
Skills
- Attention to detail
- Event planning
- Verbal and written communication
- Organizational skills
- Creativity and conceptualization
- Interpersonal skills
- Claims evaluation
- Negotiation techniques
- Fraud investigation
- Legal document interpretation
- Insurance regulations
- Customer relationship management
- Team collaboration
- Data analysis
- Problem solving
- Time management
- Accident investigations
- Liability denials
Deliverables
- Microsoft Office Suite
- Superior Leadership & Mentoring
- Campaign Management
- Adobe InDesign
- Advertising, Accounting & Sales
- Canva & Adobe Illustrator Experience
- Brand Development & Strategy
- Peer Training & Team Development
- Social Media Relations
- Management & Supervision
Affiliations
- Member of Alpha Kappa Alpha Sorority, Inc
- 2024 Class of 40 under 40 Paine College Alumni
References
References available upon request.
Timeline
Claims Specialist -Injury
State Farm
09.2021 - Current
Owner/Founder
Nina Ellis & Co. Events, LLC
08.2021 - Current
Plan Change/Operations Lead
Aliera Companies/Tatic Edge Solutions, LLC
01.2018 - 08.2021
Master of Business Administration - Marketing
Strayer University
Bachelor of Arts - Mass Communications & Public Relations
Paine College
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