LADYSHER NANDWA
Insurance Claims
Frisco,TX
Summary
Detail-oriented claims specialist with five years of experience in insurance, specializing in liability assessment, dispute resolution, and claim investigation. Proven ability to analyze facts, apply policy guidelines, and deliver fair, unbiased decisions. Strong communicator with a track record of resolving conflicts and negotiating outcomes. Eager to transition into an arbitration role where critical thinking and objective decision-making are key.
Overview
14
14
years of professional experience
2
2
Certifications
Work History
Claims Specialist II
GEICO, Government Employees Insurance
Richardson, TX
02.2025 - Current
- Improved claim processing efficiency by streamlining workflows and implementing time-saving strategies which handling an average of 20 calls and emails per day from customers.
- Managed a high volume of claims effectively by prioritizing tasks and maintaining excellent organizational skills.
- Maintained accurate records by diligently updating claim files and ensuring all required documentation was submitted in a timely manner.
- Provided exceptional customer service during stressful situations by offering empathy and support while resolving issues efficiently.
Claims Specialist (Auto-Injury)
State Farm Insurance Companies
Richardson, TX
06.2023 - 05.2024
- Investigated, evaluated, negotiated, and settled claims.
- Applied knowledge of policies and insurance regulations when determining coverage, liability, and damages.
- Reviewed medical records, bills and treatment plans.
- Assessed severity and whether treatment was reasonable/ related to the accident
- Made settlement offers and handled counteroffers
- Contacted customers via telephone, written correspondence, and various electronic media.
- Effectively managed work through task-driven queues while multitasking in a fast-paced call center environment.
Operations Staff II
Guidehouse Consulting GMS Practice
Lewisville, TX
04.2022 - 03.2023
- Reviewed 35 - 40 accounts per day
- Worked with the Engagement Center and Patient Service Representatives to verify proper insurance coverage.
- Submitted past-due unresponsive patient balances to the collection agency.
- Reviewed the explanation of benefits (EOB) for patterns of rejected claims.
- Worked with outside billing agencies to resolve billing issues.
- Recorded patient payments into EMR.
- Completed all business-related requests and correspondence from patients and insurance companies.
- Completed all assigned projects in a timely manner.
- Escalated denial or payment variance trends to leadership team for payor escalation.
- Other duties as assigned.
Patient Service Rep
United Healthcare
Plano, TX
01.2015 - 03.2022
- Educated members about their pharmacy benefits.
- Investigated simple pharmacy claim issues and helped resolve pharmacy issues and complaints.
- Provided day-to-day operational support for pharmacy questions via phone and/or email.
- Solved Rx claim issues with pharmacy providers/provider representatives.
- Contacted patients in a timely manner using their established communication preferences (phone, email, online form, text, fax, & EHR) to schedule prescription refills. Accurately documented outbound call status and follow-up plan as applicable in computer systems to ensure timely and accurate processing of refills.
- Informed customers of any changes or delays in their orders due to product shortages, product changes, recalls, or backordered and discontinued products.
- Contacted pertinent customers/patients on a monthly basis to confirm current prescriptions, changes in prescriptions, or any additional prescriptions.
- Reviewed patients' medication needs and advised of early/late refills due in the Pharmacy Management System (per prescriptions from physicians).
- Initiated discussions with patients, as necessary, regarding accounts receivable balances if status jeopardized service delivery.
- Updated Pharmacy Management System patient/customer records with all appropriate and necessary documentation.
- Resolved all order discrepancies interfacing with the appropriate departments to ensure resolution.
Medical Claim Specialist/ Collector
The Legacy @ Home
Plano, TX
05.2012 - 12.2014
- Followed up on unpaid claims within standard billing cycles and collaborated with insurance companies to resolve denials and other issues.
- Tracked and followed ADR/Appeals from filing until adjudication, maintaining clear, concise documentation.
- Contacted payers to determine claim status and made necessary corrections.
- Assisted with credit balance resolution and completed re-bill requests as necessary.
- Monitored contracts and single patient agreements to ensure appropriate reimbursement.
- Independently reviewed, submitted/followed up, documented, and collected billing on denied hospital medical claims.
- Effectively communicated and corresponded with insurance companies and healthcare providers, optimizing claim recovery.
- Collaborated with internal and external departments to ensure resolutions.
- Followed up on claims using payer websites and via phone, and performed any other duties or responsibilities as required or assigned.
Education
Certification - Vocational Nursing
Collin County Community College
Bachelor of Arts - Communications
Strathmore University
Skills
- Insurance Policy Management
- Risk Assessment
- Client relationship building
- Sales strategies
- Conflict Resolution
- Negotiation Skills
- Decision making
Certification
Texas Department of Insurance (TDI) – Texas property & Casualty Insurance All Lines Adjuster
Timeline
Claims Specialist II
GEICO, Government Employees Insurance
02.2025 - Current
Claims Specialist (Auto-Injury)
State Farm Insurance Companies
06.2023 - 05.2024
Operations Staff II
Guidehouse Consulting GMS Practice
04.2022 - 03.2023
Patient Service Rep
United Healthcare
01.2015 - 03.2022
Medical Claim Specialist/ Collector
The Legacy @ Home
05.2012 - 12.2014
Certification - Vocational Nursing
Collin County Community College
Bachelor of Arts - Communications
Strathmore University