Marquise Lee
Mexia,TX
Summary
Adept at navigating complex insurance landscapes, I leveraged critical thinking and active listening to resolve claims and exceed client expectations at National General Insurance Company. My expertise in policy interpretation and caseload management, coupled with a compassionate approach, drove high success rates in claim resolutions and client satisfaction.
Overview
9
9
years of professional experience
Work History
Claims Adjuster Consultant
National General Insurance Company
WFH TEXAS
09.2022 - Current
- Managed large caseloads effectively, prioritizing tasks to ensure prompt attention to urgent matters.
- Provided expert advice on coverage limits and exclusions, helping clients make well-informed decisions about their insurance needs.
- Resolved complex claims, utilizing expert knowledge of policy coverage and industry regulations.
- Negotiated favorable settlements for clients, maintaining a high success rate in claim resolutions.
- Reviewed policy applications for accuracy, identifying errors that could impact future claims processing or payouts.
- Examined claims forms and other records to determine insurance coverage.
- Contributed to a positive work environment through active participation in team meetings and collaborating on cross-functional projects.
- Provided exceptional customer service during emotionally difficult situations for policyholders following accidents or natural disasters.
- Answered customer questions regarding deductibles.
- Evaluated coverage accurately by interpreting complex insurance policies and applying them to specific claim scenarios.
Social Worker
Texas Department of Family Protective Services
Mexia, TX
01.2016 - 08.2022
- Ensured accurate and compliant client records through updated documentation.
- Conducted interviews to evaluate client, family, and group situations to identify limitations and issues.
- Collaborated with multidisciplinary teams to ensure appropriate care coordination and resource allocation for clients.
- Educated families on available community resources, connecting them with essential services such as housing assistance, financial aid, or healthcare providers.
- Supported clients and families with empathy and compassion during difficult times.
- De-escalated stressful situations through individual and family crisis interventions.
- Maintained accurate case documentation, ensuring compliance with regulatory standards and facilitating informed decision-making by team members.
- Advocated for clients to assure respected rights and wishes.
- Maintained regular contact with clients by calling and visiting clients' homes.
- Conducted home visits to assess living environment and facilitate access to necessary resources.
- Helped clients develop new coping mechanisms and techniques to drive behavior modification.
Eligibility Specialist
Texas Department of Health and Human Services
Mexia, TX
06.2018 - 06.2021
- Reduced errors in eligibility determinations by maintaining thorough knowledge of program guidelines and regulations.
- Enhanced client satisfaction by providing timely and accurate eligibility determination for various assistance programs.
- Provided exceptional customer service through prompt response times, clear communication channels, and diligent follow-up practices.
- Ensured compliance with local, state, and federal regulations during all phases of the eligibility determination process.
- Assisted clients with accurate eligibility form, application and document completion.
- Interviewed applicants and explained scope of different available benefits.
- Processed and certified documents for accuracy and compliance with government regulations.
- Streamlined application process for clients by implementing efficient case management techniques, improving overall service.
- Communicated with people from various cultures and backgrounds on application process.
- Developed strong rapport with clients by effectively communicating complex program requirements and processes.
- Increased efficiency in the review process by proactively identifying potential issues and developing actionable solutions.
Education
High School Diploma -
Penn Foster High School
06.2008
Skills
- Critical thinking
- Claims investigation
- Active listening
- Highly motivated
- Team collaboration
- Claims processing
- Advanced oral and written communication skills
- Decision-making
- Settlement negotiation
- Risk assessment
- Caseload management
- Policy interpretation
- Casualty and property loss
- Policy investigations
Timeline
Claims Adjuster Consultant
National General Insurance Company
09.2022 - Current
Eligibility Specialist
Texas Department of Health and Human Services
06.2018 - 06.2021
Social Worker
Texas Department of Family Protective Services
01.2016 - 08.2022
High School Diploma -
Penn Foster High School