Hi, I’m
Lacondia Moore
Plainfield,IL
Summary
Qualified Claims Representative versed in investigating claims, verifying information and managing settlements. Friendly and upbeat team player with organized and disciplined approach. Offering 20 years of insurance experience.
Overview
5
years of professional experience
1
Certification
Work History
CNA Insurance
Complex Claim Representative- EPL
11.2023 - Current
Job overview
- Handle employment claims involving professional liability, management liability, and specialized financial products
- Negotiated settlement agreements that were mutually beneficial for both clients and the company while maintaining professional relationships.
- Conduct thorough investigations to assess the validity and extent of claims, including detailed reviews of financial records and policy terms
- Maintain up-to-date knowledge of industry trends, regulatory changes, and best practices in financial lines claims
- Provide exceptional service to policyholders by clearly explaining claim processes and addressing concerns promptly
- Developed and maintained strong relationships with brokers, policyholders, and legal counsel
- Delivered training sessions to junior adjusters on best practices for handling financial lines claims
- Consistently achieved performance targets for claim resolution times and customer satisfaction.
CNA Insurance
Claim Technician - EPL
11.2022 - 11.2023
Job overview
- Contributes to customer satisfaction by interacting professionally and effectively with insureds, claimants and business partners, achieving quality and cycle time standards, providing regular, timely updates and responding promptly to inquiries and requests for information
- Conducted audits of closed claims to ensure compliance with company guidelines, resulting in fewer errors and increased accuracy.
- Stayed current on industry regulations through regular professional development courses, applying updated knowledge to daily tasks for optimal performance.
MetLife Insurance Company
STD/FMLA Claim Specialist
07.2021 - 11.2022
Job overview
- Effectively and independently manages an assigned caseload of active claims
- Provides timely, balanced, and accurate claims reviews, documentation and recommended decisions in a time sensitive and fast-paced environment and in accordance with state and department of insurance regulations
- Compiles file documentation and correspondence requiring extensive policy and factual detail
- Analyzes information to determine if additional information is needed to make a reasonable and logical claims determination based off the information available
- Collaborates effectively with both external and internal resources, such as physicians, attorneys, clinical and vocational consultants, as needed, to gather data such as medical/occupational information to ensure reasonable, thorough decision
- Clarifies and reconciles inconsistencies when gathering information during claim evaluations and collaborates with Fraud Waste and Abuse resources as needed
- Proficiently calculates monthly benefits due after elimination period, to include COLA, Social Security Offsets, and Rehab Return to Work benefits, and other non-routine payments.
Life Stance Health
Healthcare Insurance Verification Specialist
12.2019 - 07.2022
Job overview
- Verified client information by analyzing existing evidence on file.
- Determined appropriateness of payers to protect organization and minimize risk.
- Stayed up-to-date on industry trends and regulations, adapting verification practices accordingly to maintain compliance.
- Maintained accurate records of all verifications performed, ensuring easy access and retrieval when required by audit or management review.
- Contributed to company''s bottom line by reducing write-offs due to incorrect or outdated insurance information through diligent verification efforts.
- Complied with HIPAA guidelines and regulations for confidential patient data.
Education
College of DuPage
Business Administration, Management and Operations
12.2016
Skills
- Personal Development
- Customer Service
- Communication
- Liability
- Technical
- Accuracy
- Documentation
- Claims Investigation
- Microsoft Office
- Policy Knowledge
- Time Management
- Decision-Making
- Team Collaboration
Certification
Texas/Florida Claim Adjuster License
Personal Information
Title: Claim Technician
References
Available upon request.
Timeline
Complex Claim Representative- EPL
CNA Insurance
11.2023 - Current
Claim Technician - EPL
CNA Insurance
11.2022 - 11.2023
STD/FMLA Claim Specialist
MetLife Insurance Company
07.2021 - 11.2022
Healthcare Insurance Verification Specialist
Life Stance Health
12.2019 - 07.2022
College of DuPage
Business Administration, Management and Operations
Similar Profiles
Terry CoseoTerry Coseo
Claims Specialist at CNA InsuranceClaims Specialist at CNA Insurance
Iris BursiagaIris Bursiaga
Underwriting Associate at CNA InsuranceUnderwriting Associate at CNA Insurance
Lisa BrownLisa Brown
Business Process Consultant at CNA InsuranceBusiness Process Consultant at CNA Insurance
Sarah HarrisSarah Harris
Underwriter Technician at CNA InsuranceUnderwriter Technician at CNA Insurance
Sara MerrittSara Merritt
Site Leader/General Manager at Tommy's Express Car WashSite Leader/General Manager at Tommy's Express Car Wash