Kuda Hungwe
Plano,TX
Summary
Claims Adjuster with extensive experience in high-volume claims management, specializing in investigation and settlement negotiation. Demonstrates a strong track record in policy compliance, liability assessment, and fraud prevention, contributing to efficient resolution and enhanced client satisfaction.
Overview
1
1
Certification
12
12
years of professional experience
Work History
Claims Representative
Careington
Frisco, Texas
10.2025 - Current
- Dental Benefits: Verify member eligibility and active coverage; review dental plan benefits, limitations, exclusions, deductibles, annual maximums, tooth history, prior services, waiting periods, procedure codes, claim denials, EOBs, and participating/non-participating providers. Vision Benefits: Verify eligibility and coverage; review benefits for exams, lenses, frames, contacts, copays, deductibles, frequency requirements; assist with in-network and out-of-network provider searches and claim discrepancies. Hearing Benefits: Verify eligibility and coverage; review hearing-related benefits, limitations, deductibles, maximums, and plan requirements. claims, EOBs, and participating providers; explain in-network versus out-of-network coverage. CLAIMS & MEMBER ADVOCACY SKILLS • Benefit Details: Accurately review and explain plan benefits, limitations, exclusions, deductibles, copays, and maximums. • Eligibility & Coverage: Verify member eligibility, effective dates, active/inactive account status, and applicable coverage. • Researched denied claims to identify issues related to eligibility, coding, documentation, or plan coverage. • Code Verification: Review procedures and diagnosis codes and compare services against applicable coverage and benefit guidelines. • EOB Review: Explain Explanation of Benefits statements, including allowed amounts, plan payments, member responsibility, deductibles. and denial information. • Provider Searches: Locate participating providers and explain differences between in-network and out-of-network benefits. • Account Research: Review account status, claim history, prior services, benefit utilization, and available coverage information. • Customer Advocacy: Serve as a liaison between members, providers, and insurance organizations to help resolve benefit and claim concerns.
- Processed claims efficiently, ensuring compliance with company policies and procedures.
- Communicated with clients to gather necessary information for claim evaluations.
- Reviewed documentation to determine claim eligibility and completeness.
Claims Adjuster
Progressive Insurance
Dallas, TX
06.2019 - 06.2024
- Conducted investigations to ascertain coverage, liability, and damage assessments, coordinating field inspections and expert consultations to support informed decision-making.
- Engaged claimants and stakeholders to set clear expectations and evaluate potential risks, developing strategic plans for timely claim resolution.
- Negotiated settlements for property and bodily injury claims within designated authority, maintaining accurate records and ensuring compliance with industry standards.
- Analyzed policy documents to verify coverage, limits, and deductibles in alignment with company protocols, facilitating the prompt escalation of complex cases.
Claims Examiner
AON
Remote
05.2016 - 05.2019
- Negotiated and settled claims through direct communication with policyholders, ensuring mutually satisfactory outcomes.
- Investigated and processed travel interruption and cancellation claims, while maintaining a high volume of case resolutions per week.
- Focused on fraud prevention and budget efficiency within claims team, achieving a 95% quality standard.
Inside Property Claims Adjuster
Global Claims Service
Dallas, TX
08.2014 - 05.2016
- Assessed property damage and compiled evidence, ensuring precise valuation of claims to facilitate timely settlements.
- Negotiated settlements with carriers, claimants, and attorneys, leveraging strong communication and conflict resolution skills to achieve favorable outcomes.
- Investigated liability claims, determining accountability through detailed analysis of negligence and vehicle condition to support fair resolutions.
Education
Associate's Degree - Business Administration
Wiley College
Marshall, TX04-2021
GED, High School Diploma -
Victoria High School
Zimbabwe12-1994
Skills
- Claims management
- Claims analysis
- Settlement negotiation
- Liability evaluation
- Fraud detection
- Regulatory compliance
- Insurance Data Analysis
- Insurance Analytics
- Claims Management Software
- Salesforce
- Microsoft Office
- Navigator
- Client interactions
Certification
PowerBI Developer, Microsoft 365 2024, Business and Data Analysis, Collabra University 2023
Timeline
Claims Representative
Careington
10.2025 - Current
Claims Adjuster
Progressive Insurance
06.2019 - 06.2024
Claims Examiner
AON
05.2016 - 05.2019
Inside Property Claims Adjuster
Global Claims Service
08.2014 - 05.2016
Associate's Degree - Business Administration
Wiley College
GED, High School Diploma -
Victoria High School