Natasha Adams
Galax ,VA
Summary
Dynamic CL Claims Generalist with extensive experience at Progressive, excelling in claims investigation and fraud detection. Proven ability to enhance team performance through coaching and analytical thinking. Recognized for delivering exceptional customer service and implementing process improvements, ensuring compliance and operational efficiency in a fast-paced environment.
I have a knack for complex investigations and data mining to bring to light any red flags. I have a passion for joining SIU to be a team player on a larger scale in deterring and preventing fraud as well as developing processes that will help every level of claims holistically.
Overview
3
3
years of professional experience
Work History
CL Claims Generalist INT
Progressive
09.2024 - Current
- Processed claims efficiently, ensuring compliance with company policies and state regulations.
- Assisted in resolving customer inquiries related to claim status and coverage details.
- Analyzed claim documentation to determine validity and identify potential fraud risks.
- Collaborated with cross-functional teams to enhance claims processing workflows.
- Trained new team members on claims procedures and best practices for accuracy.
- Presented findings from complex investigations at internal meetings, contributing valuable insights to ongoing improvement efforts within the department.
- Identified fraudulent claims through meticulous examination of evidence, protecting the company from financial loss.
- Organized detailed records for each claim, enabling quick retrieval of information when needed.
- Participated in regular team meetings focused on identifying areas for improvement and implementing effective strategies to address them.
- Served as a mentor to junior staff members, providing guidance on best practices in handling difficult cases effectively.
- Maintained a positive work environment by fostering open communication, collaboration, and continuous learning among team members.
- Analyzed historical data to identify trends in claim types and frequency, aiding in the development of targeted risk mitigation strategies.
- Monitored team performance, enforcing compliance with corporate claims processes and procedures.
CL Claims Generalist
Progressive
01.2024 - 09.2024
- Evaluated and processed insurance claims efficiently, ensuring compliance with company policies.
- Communicated with clients to gather necessary information and clarify claim details.
- Collaborated with team members to resolve complex claims issues and enhance workflow efficiency.
- Reviewed documentation for accuracy, preventing potential errors in claims processing.
- Conducted thorough investigations on disputed claims, providing detailed reports for management review.
- Utilized claims management software to track and manage case progress effectively.
- Identified opportunities for process improvements, contributing to enhanced operational effectiveness within the team.
- Collaborated with various departments to expedite claim settlements and improve overall efficiency.
- Conducted comprehensive investigations for complex claims, resulting in accurate assessments and fair settlements.
- Provided exceptional customer service, addressing concerns with empathy and professionalism during the claims process.
- Delivered consistent results by handling high volumes of insurance claims under strict deadlines.
- Enhanced customer satisfaction through prompt and accurate resolution of claim disputes.
- Analyzed information gathered by investigation and reported findings and recommendations.
- Identified fraudulent claims through meticulous examination of evidence, protecting the company from financial loss.
- Organized detailed records for each claim, enabling quick retrieval of information when needed.
- Participated in regular team meetings focused on identifying areas for improvement and implementing effective strategies to address them.
- Maintained a positive work environment by fostering open communication, collaboration, and continuous learning among team members.
- Analyzed historical data to identify trends in claim types and frequency, aiding in the development of targeted risk mitigation strategies.
- Monitored team performance, enforcing compliance with corporate claims processes and procedures.
Central Claims Unit
Progressive
09.2022 - 01.2024
- Self-motivated, with a strong sense of personal responsibility.
- Worked effectively in fast-paced environments.
- Skilled at working independently and collaboratively in a team environment.
- Proven ability to learn quickly and adapt to new situations.
- Excellent communication skills, both verbal and written.
- Worked well in a team setting, providing support and guidance.
- Demonstrated respect, friendliness and willingness to help wherever needed.
- Passionate about learning and committed to continual improvement.
- Worked flexible hours across night, weekend, and holiday shifts.
- Managed time efficiently in order to complete all tasks within deadlines.
- Used critical thinking to break down problems, evaluate solutions and make decisions.
- Strengthened communication skills through regular interactions with others.
- Demonstrated strong organizational and time management skills while managing multiple projects.
- Developed and maintained courteous and effective working relationships.
Education
Associate of Applied Science - Medical Laboratory Science
Wytheville Community College
Wytheville, VA05.2016
Skills
- Claims investigation
- Claims analysis
- Policy interpretation
- Analytical thinking
- Extensive knowledge of claims tools such as PDSuite, ClaimPro, ISO, Accurint, Intellitruck
- Intermediate knowledge of Microsoft Office tools, such as Word, Excel, and Access
- Willingness and ability to learn and expand scope of knowledge and skills
- Coaching and mentoring peers
- Conflict resolution
- Expert with task prioritization and time management
- Team building
- Workload prioritization
- Decision-making
- Excellent verbal and written communication
- Fraud detection
- Fraudulent claims investigation working closely with SIU for resolution of complex issues
- Sourcing and compiling information through analytics to improve team performance holistically
- Ability to interact with all levels of claims organization
Timeline
CL Claims Generalist INT
Progressive
09.2024 - Current
CL Claims Generalist
Progressive
01.2024 - 09.2024
Central Claims Unit
Progressive
09.2022 - 01.2024
Associate of Applied Science - Medical Laboratory Science
Wytheville Community College