Marnee Hales
Clarence,NY
Summary
Adaptable Claims Generalist Associate known for maintaining high productivity levels and completing tasks efficiently. Possess specialized skills in claim processing, dispute resolution, and policy interpretation which enable precise and timely claim management. Excel in communication, problem-solving, and time management, ensuring seamless operations within fast-paced environments.
Overview
4
4
years of professional experience
Work History
Claims Adjuster-NCRT
Progressive
Cleveland, Ohio
01.2024 - Current
- Utilized computer systems such as Microsoft Office Suite and specialized software programs used by the company.
- Adhered strictly to departmental guidelines; ensured that all activities were compliant with applicable state laws.
- Maintained accurate documentation of all claim activity within designated system.
- Negotiated settlements with claimants or their representatives in order to resolve disputes quickly and economically.
- Researched relevant laws, regulations, legal decisions and precedents to determine appropriate course of action.
- Assisted colleagues with difficult cases; provided guidance regarding complex issues or scenarios.
- Investigated insurance claims, reviewed coverage and liability, prepared reports and recommended payment or denial of claims.
- Ensured timely follow-up on all open matters; kept stakeholders informed regarding status updates.
- Analyzed facts of loss including photographs, diagrams and other evidence to identify potential sources of recovery.
- Interpreted policy language to determine coverage for insureds under various lines of business.
- Organized files into logical categories; maintained complete records according to established procedures.
- Drafted statement of loss to summarize damages, payments and underlying policy coverage.
- Reviewed, evaluated and adjusted claims to promote fair and prompt settlement.
- Completed required investigations on referred files within established timeframes.
- Calculated and authorized payment of claims within designated authority level.
- Discovered occurrences of insurance fraud or criminal neglect to avoid workplace liability.
- Resolved claim disputes through mediation and negotiation, minimizing the need for litigation.
- Managed caseload effectively, prioritizing urgent or high-value claims for prompt attention.
Claims Adjuster -FTW
Progressive
Cleveland, OH
06.2022 - 01.2024
- Adhered strictly to departmental guidelines; ensured that all activities were compliant with applicable state laws.
- Maintained accurate documentation of all claim activity within designated system.
- Utilized computer systems such as Microsoft Office Suite and specialized software programs used by the company.
- Worked collaboratively with team members across multiple departments; identified areas where processes could be improved.
- Organized files into logical categories; maintained complete records according to established procedures.
- Analyzed facts of loss including photographs, diagrams and other evidence to identify potential sources of recovery.
- Ensured timely follow-up on all open matters; kept stakeholders informed regarding status updates.
- Interpreted policy language to determine coverage for insureds under various lines of business.
- Completed required investigations on referred files within established timeframes.
- Drafted statement of loss to summarize damages, payments and underlying policy coverage.
- Utilized claim handling software to document and manage claim files efficiently.
- Interpreted insurance policy language to apply appropriate coverage.
- Calculated and authorized payment of claims within designated authority level.
Case Manager
The Salvation Army
Buffalo, New York
01.2021 - 07.2022
- Educated clients about mental health conditions, medications and self-care techniques.
- Provided crisis intervention support for clients in emergency situations.
- Collaborated with medical professionals to coordinate treatment plans for clients.
- Collaborated with other service providers to ensure continuity of care for clients.
- Participated in interdisciplinary team meetings to discuss treatment options.
- Participated in professional development activities related to case management best practices.
- Conducted home visits to assess the safety of living environments for clients.
- Counseled clients on available resources within the community that could help meet their needs.
- Acted as an advocate for vulnerable populations by advocating for policy changes at the state level.
- Monitored client progress through regular follow-up contacts.
- Facilitated communication between clients, families, caregivers, social services and other agencies to ensure client needs were met.
- Assisted with applications for government benefits such as Medicaid or Social Security Disability Insurance.
- Coordinated transportation services for clients who lacked access to reliable transportation.
- Compiled reports on cases and submitted them to supervisors as required.
- Maintained accurate case records and documentation according to agency guidelines.
- Provided referrals to appropriate health care providers or other community resources.
- Developed individualized care plans with input from clients and their families.
- Advocated for clients by obtaining information regarding treatment options and clinical status.
- Linked clients with social services, health care providers and governmental agencies to help claim or reclaim individual autonomy.
Education
Bachelor of Arts - Psychology
SUNY Buffalo State
Buffalo, NY05-2020
Skills
- Claims processing
- Claims investigation
- Insurance regulations
- Settlement agreements
- Coverage determination
- Conflict resolution
- Insurance claims review
- File management
- Settlement negotiation
- Coverage assessments
- Team collaboration
- Time management
- Decision-making
- Documentation review
- Microsoft office
- Interpersonal communication
Timeline
Claims Adjuster-NCRT
Progressive
01.2024 - Current
Claims Adjuster -FTW
Progressive
06.2022 - 01.2024
Case Manager
The Salvation Army
01.2021 - 07.2022
Bachelor of Arts - Psychology
SUNY Buffalo State