Nicole Mancusi
Jarrell
Summary
Dynamic Claims Examiner with extensive experience at Continental General, adept at claims processing and customer service. Proven track record in reducing processing errors and enhancing workflow efficiency. Skilled in data verification and relationship building, consistently delivering exceptional support while maintaining regulatory compliance and confidentiality. Committed to fostering positive client experiences and resolving complex issues effectively.
Professional in claims management, equipped to drive accurate and efficient claim resolutions. Proven track record in handling diverse cases and ensuring compliance with regulatory standards. Known for strong team collaboration and adaptability, bringing valuable problem-solving skills and reliability to every project.
Overview
15
15
years of professional experience
Work History
Claims Examiner
Continental General
08.2022 - 12.2025
- Reviewed and processed insurance claims to ensure compliance with company policies and regulations.
- Evaluated claims for accuracy, identifying discrepancies and initiating necessary investigations.
- Served as a liaison between policyholders, providers, and internal teams to resolve complex claims issues efficiently.
- Handled sensitive information with discretion, ensuring confidentiality of personal and financial details for claimants throughout the claims examination process.
- Utilized analytical skills to evaluate medical bills for accuracy and appropriateness of charges before approving payments as part of the claims process.
- Reduced claim processing time by implementing efficient workflow strategies and prioritizing tasks effectively.
- Enhanced customer satisfaction by promptly addressing inquiries and providing accurate information on claim status.
- Maintained detailed records of all claims activities, ensuring compliance with regulatory requirements and company policies.
- Finalized files for insurance claim payment release.
- Provided exceptional customer service by empathetically addressing claimants'' concerns and effectively explaining the claims process to them.
- Maintained current knowledge of industry developments, regulations, and best practices through continuous professional development activities.
- Mitigated fraud risks by identifying suspicious patterns in claims data and escalating concerns to appropriate teams for further investigation.
- Examined photographs and statements.
- Managed caseloads effectively while maintaining high-quality work standards and meeting strict deadlines consistently.
- Read over insurance policies to ascertain levels of coverage and determine whether claims would receive approvals or denials.
- Examined claims forms and other records to determine insurance coverage.
- Identified insurance coverage limitations with thorough examinations of claims documentation and related records.
- Delivered exceptional customer service to policyholders by communicating important information and patiently listening to issues.
- Identified suspicious losses and contacted manager for investigative assistance.
- Managed documentation and records management systems to maintain organized claim files.
Claims Examiner/Producer Maintenance
Boon Chapman/Kemper Senior Solutions
05.2014 - 08.2022
- Evaluated and processed insurance claims to ensure compliance with company policies.
- Analyzed claim documentation for accuracy and completeness, reducing processing errors.
- Collaborated with internal teams to resolve complex claim issues efficiently.
- Trained junior examiners on best practices and regulatory requirements in claims processing.
- Implemented process improvements, enhancing overall efficiency of claims review workflow.
- Mentored staff on effective communication strategies for client interactions regarding claims status.
- Participated in cross-functional team meetings to address organizational challenges related to claims management and develop solutions collaboratively.
- Researched claims and incident information to deliver solutions and resolve problems.
- Managed client relationships to ensure satisfaction and retention.
- Trained new agents on operational procedures and best practices.
- Maintained accurate records of client communications, transactions, policies, and other relevant documentation for seamless operations within the agency.
- De-escalated and resolved customer complaints with punctual, polite and professional service.
- Delivered exceptional customer service by proactively addressing concerns and fostering a positive experience throughout all interactions.
- Assisted clients in navigating the claims process, ensuring timely resolution of issues and optimal outcomes.
- Streamlined documentation process, reducing turnaround time for contract approvals.
- Increased customer satisfaction with personalized follow-up strategies.
- Generated reports detailing findings and recommendations.
- Communicates clearly with policyholders, beneficiaries, internal employees and Reserve National.
- Analyzes claims to determine eligibility, medical facts, policy coverage and limitations.
- Investigates questionable claims by requesting medical records.
- Evaluates and identifies any issues with commission payments and initiates the corrections.
- Assists agents with questions and paperwork.
- Maintains files of correspondence, records and reports
- Processes renewals and terminations.
ECC Loan Counselor II/ HLS Ambassador
OneWest Bank
01.2011 - 09.2013
- Receive inbound calls from customers/clients regarding account inquiries and general information
- handling very sensitive information while providing customer service
- Make outbound calls to follow up on customer inquiries, also collections.
- primary duties were to field mortgage related inbound calls from customers, answer general inquiry questions, update database with account information and follow up with customers.
- Assist with modification process and repayment plans, reinstatements, short sales, deed in lieu.
- Developed personalized financial plans for clients, aligning loan options with long-term financial goals.
- Examined customer loan applications for loan approvals and denials.
- Contributed to a positive workplace culture that prioritized teamwork, collaboration, and continuous learning opportunities for all employees involved in the lending process.
- Maintained compliance with regulatory requirements through diligent documentation and accurate record-keeping practices.
- Handled customer complaints with relative ease by conducting research, listening carefully, and taking appropriate action.
- Collaborated with underwriters to expedite loan approvals, ensuring timely funding for borrowers.
- Negotiated loan terms and conditions with customers to secure best deal.
Education
High School Diploma -
Franklin Delano Roosevelt
Hyde Park, NYAssociate of Applied Business - Human Resources Management
Dutchess Community College
Poughkeepsie, NYSkills
- Claims processing
- Verbal communication
- Data verification
- Disability claims process
- Policy interpretation
- Microsoft Office Suite
- Coverage analysis
- Investigative skills
- Coding systems
- Computer skills
- Claims evaluation
- Decision-making
- Customer service and support
- Payment processing
- Critical thinking
- Claims
- Denied claims identification
- MS office
- Coverage determination
- Relationship building
- Team collaboration
- Records review
- Benefits review
- Policy investigations
- Regulatory compliance
- Coaching and mentoring
- Multitasking
- Attention to detail
- Problem-solving abilities
- Time management
- Reliability
- Excellent communication
- Organizational skills
- Medical terminology
- Data entry efficiency
Timeline
Claims Examiner
Continental General
08.2022 - 12.2025
Claims Examiner/Producer Maintenance
Boon Chapman/Kemper Senior Solutions
05.2014 - 08.2022
ECC Loan Counselor II/ HLS Ambassador
OneWest Bank
01.2011 - 09.2013
High School Diploma -
Franklin Delano Roosevelt
Associate of Applied Business - Human Resources Management
Dutchess Community College