MELISSA REEVE
Moreno Valley,CA
Summary
Reliable and upbeat sales associate, successful at promoting customer loyalty and satisfaction with consultative techniques and diligent attention to individual needs. Dedicated and dependable relationship builder with excellent organizational strengths and superior work ethic.
Overview
15
15
years of professional experience
1
1
Certificate
Work History
Workers' Compensation Claims Adjuster
Travelers Insurance Company
Diamond Bar, CA
03.2022 - 07.2022
- Examined claims forms and other records to determine insurance coverage.
- Verified insurance claims and determined fair amount for settlement.
- Evaluated insurance policies and analyzed damages to determine coverage.
- Reviewed police reports, medical treatment records and to determine extent of liability.
- Documented all investigation activity and presented reports to management.
- Answered questions posed by insured and attorneys.
- Conduct investigations, including, but not limited to assessing policy coverage, investigation of non-questionable/questionable claims, contacting insureds, injured workers, medical providers, and other parties in a timely manner to determine compensability.
- Conducted comprehensive interviews of witnesses and claimants to gather facts and information.
- Reviewed new files to determine current status of injury claim and to develop plan of action.
- Partnered with legal counsel on litigation cases.
- Establish and update reserves to reflect claim exposure and document rationale. Identify exposures and establish appropriate reserves. Apply knowledge to determine causal relatedness of medical conditions.
- Collaborate with internal nurse resources (Medical Case Manager) in order to integrate the delivery of medical services into the overall claim strategy.
- Complete required letters and state forms and any other required documents as required. Prepare necessary letters and state filings within statutory limits.
- Determine and actively develop ongoing strategic plans for resolution as required. Develop strategies to manage losses involving issues of statutory benefit entitlement, medical diagnoses, Medicare Set Aside to achieve resolution through the best possible outcome. Work in collaboration with specialty resources (i.e. medical and legal) to proactively pursue claim resolution opportunities.
- Achieve a positive end result by returning injured party to work and coordinating the appropriate medical treatment in collaboration with internal nurse resources where appropriate. Manage, resolve or reassign those claims where pre-injury return to work is unlikely.
Licensed Sales Producer
Allstate Insurance
Rancho Cucamonga, CA
04.2021 - 12.2021
- Meet new business production goals and objectives as established
- Solicit new business via telephone, networking, and other lead sources provided by agency
- Developed ongoing networking relationships with Real Estate Agents and Mortgage Lenders
- Developed new Financial Services opportunities
- Followed all underwriting, rating, and compliance requirements
- Presented and explained insurance policy options based upon prospective client needs and their personal goals.
- Managed over 150+ outbound calls per day
- Utilized targeted email campaigns and cold calling to increase revenue
- Attended continuing education courses and workshops to gain additional insurance industry knowledge
- Provided coverage option information to assist clients in protecting assets
Customer Service Representative
Allstate Insurance
Rancho Cucamonga, CA
07.2020 - 04.2021
- Assisting clients with their insurance needs and making changes to existing accounts, meeting service delivery standards and performing essential functions to achieved quality and service standards developed by agency
- Aid producers or assigned Account Executives in the handling and processing of new and renewal P&C business
- Duties involved completing apps or preparing renewals for upcoming renewal term
- Prepare insurance proposals and submit apps to eligible carriers
- Perform all necessary rating sufficient for policy quotation and/or issuance on carrier websites
- Answer high volume phone calls/emails from insurance agents/insureds/insurance reps
- Attend weekly meetings with producers on status of workflow/monthly new business targets
- Meet directly with marketing representatives from insurance carriers on new products of coverages to new or current clients to sell more coverage
- Determine charges for services requested, collect payments, arrange billings, and collection calls
- Solicit sales of new or additional services and/or products
- Collaborate with Underwriters, Account Executive, and Claims Examiners, to help develop plans for new business or how to improve existing business
- Contact policyholders to deliver or explain policy, analyze insurance programs, or suggest additions or changes to ensure client is properly covered.
- Quickly and accurately answered customer questions, suggested effective solutions and resolved issues to increase customer satisfaction
Client Relations Specialist
ABI Document Support Services
Loma Linda, CA
08.2005 - 01.2018
- Respond to clients regarding status of Subpoena/Medical Authorization requests to obtain medical records
- Compile work in progress reports to Customer Service Supervisor
- Review documents and confirm HIPAA compliance was followed
- Research to locate specific business/doctors' office
- Search and confirm medical board license status and/or business license status
- Review non-compliant orders and confirm all procedures were followed
- Review all Affidavit of No Records, cross reference for validity prior to billing
- Review all Objections and/or Motions to Quash
- Monitor all Special Circumstance Orders which require tight deadlines
- Compiled Budget Reports for Customer Service Supervisor on total revenue from insurance companies.
Document Retrieval Specialist II
ABI Document Support Services
Loma Linda, CA
09.2003 - 10.2004
- Call and establish contact with custodian of records daily, according to subpoena request priority
- Escalated level of communication with custodian as order approaches due date, send 2nd and Final Notices to elicit production of records from custodians
- Enter all film breakdowns accurately and per procedure
- Shared responsibility of answering high volume in bound phone calls
- Maintain communication with other schedulers and departments to ensure a smooth workflow
- Audited database to make sure that system information is correct.
- Confirmed information that is viewable to clients is correct
Education
High School Diploma -
Norwalk High School
Norwalk, CA06.1995
Skills
- Critical Thinking
- Insurance Policy Sales
- Document Control
- Time Management
- Verbal and Written Communication
- Customer Account Review
- HIPAA Compliance
- Calm and Professional Under Pressure
- Multitasking and Prioritization
- Administrative and Office Support
- Microsoft Office Suite
- Research and Analytical Skills
Certification
CA P&C License#: 4069454
CA Claims Adjuster Total Hours of Training Completed 162.5
Timeline
Workers' Compensation Claims Adjuster
Travelers Insurance Company
03.2022 - 07.2022
Licensed Sales Producer
Allstate Insurance
04.2021 - 12.2021
Customer Service Representative
Allstate Insurance
07.2020 - 04.2021
Client Relations Specialist
ABI Document Support Services
08.2005 - 01.2018
Document Retrieval Specialist II
ABI Document Support Services
09.2003 - 10.2004
High School Diploma -
Norwalk High School
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