Nicole Simmons
Irving
Summary
Dedicated and adaptable professional with a proactive attitude and the ability to learn quickly. Strong work ethic and effective communication skills. Eager to contribute to a dynamic team and support organizational goals.
Overview
10
10
years of professional experience
1
1
year of post-secondary education
Work History
Auto Claims Adjuster
GEICO, Government Employees Insurance
Dallas
02.2025 - Current
- Evaluated auto claims for accuracy and compliance with policy guidelines.
- Communicated with customers to gather necessary claim information and documentation.
- Collaborated with repair shops to assess vehicle damage and repair estimates.
- Utilized claims management software to track claim progress and updates.
- Provided timely responses to customer inquiries regarding claim status and procedures.
- Investigated fraudulent claims by analyzing inconsistencies in submitted information.
- Determined liability based on facts gathered from investigations.
- Investigated and analyzed auto insurance claims to determine validity, accuracy, and coverage.
- Provide customer support to members, providers, billing departments and other insurance agency's regarding claims, appeals and eligibility.
- Interviewed claimants, witnesses, police officers, medical professionals and other parties involved in the claim.
- Processed payments according to terms outlined in policy contracts.
- Researched and verified insurance policy coverage.
- Analyzed policy language to ensure compliance with state regulations and company policies.
- Established relationships with attorneys, medical providers and other service providers who assist in the resolution of claims.
- Attended continuing education seminars to stay abreast of changes in the field.
- Provided exceptional customer service, addressing concerns and questions promptly.
- Communicated effectively with policyholders, explaining claim processes and decisions clearly.
Medical Claims Examiner
Gainwell Enterprises
Irving
10.2019 - 02.2025
- Evaluated medical claims for accuracy and compliance with company policies.
- Reviewed documentation to determine claim eligibility and necessary approvals.
- Collaborated with healthcare providers to clarify information on submitted claims.
- Processed claims using Gainwell's proprietary software for efficient management.
- Maintained detailed records of processed claims for future reference and reporting.
- Ensured HIPAA compliance by maintaining strict confidentiality of patient information.
- Reviewed and processed medical claims for accuracy and completeness according to established guidelines.
- Participated in process improvement initiatives aimed at streamlining workflow processes.
Medical Assistant
UT Southwestern Medical Center
Dallas
03.2017 - 05.2019
- Assisted healthcare providers with patient examinations and procedures.
- Managed patient scheduling and appointment coordination efficiently.
- Collected and recorded vital signs accurately during patient visits.
- Prepared examination rooms by ensuring cleanliness and necessary supplies.
- Conducted patient follow-ups to ensure satisfaction and care continuity.
- Educated patients on treatment plans and health maintenance strategies.
- Maintained electronic health records with attention to detail and confidentiality.
- Kept examination rooms clean, stocked with necessary supplies and prepared for incoming patients.
- Adhered to HIPAA regulations regarding safeguarding confidential patient information at all times.
- Relayed messages from patients to physicians about concerns, condition updates or refill requests to facilitate treatment.
- Documented notes during patient visits.
Medical Assistant
North Texas Foot & Ankle
Irving
02.2016 - 11.2016
- Assisted healthcare providers with patient examinations and procedures.
- Managed patient scheduling and appointment coordination efficiently.
- Collected and recorded vital signs accurately during patient visits.
- Prepared examination rooms by ensuring cleanliness and necessary supplies.
- Conducted patient follow-ups to ensure satisfaction and care continuity.
- Educated patients on treatment plans and health maintenance strategies.
- Maintained electronic health records with attention to detail and confidentiality.
- Kept examination rooms clean, stocked with necessary supplies and prepared for incoming patients.
- Relayed messages from patients to physicians about concerns, condition updates or refill requests to facilitate treatment.
- Documented notes during patient visits.
- Answered phones, scheduled appointments and managed patient flow while greeting visitors in a professional manner.
- Maintained accurate medical records through filing, charting, transcription and data entry into electronic health record system.
- Collected samples from patients for laboratory testing purposes.
- Cleaned and maintained medical equipment following procedures and standards.
- Educated patients about medications, procedures and physician's instructions.
Education
Sanford–Brown
Dallas, Tx 01.2015 - 01.2016
Chester W. Nimitz High School
Irving , TxSkills
- Claims evaluation
- Liability determination
- Claims management software
- Fraud detection
- Customer relationship management
- Communication skills
- Regulatory compliance
- Problem solving
- Attention to detail
- Team collaboration
- Customer service
- Conflict resolution
- Claims investigation
- Insurance regulations knowledge
- Critical thinking
- Time management
- Effective communication
Timeline
Auto Claims Adjuster
GEICO, Government Employees Insurance
02.2025 - Current
Medical Claims Examiner
Gainwell Enterprises
10.2019 - 02.2025
Medical Assistant
UT Southwestern Medical Center
03.2017 - 05.2019
Medical Assistant
North Texas Foot & Ankle
02.2016 - 11.2016
Sanford–Brown
01.2015 - 01.2016
Chester W. Nimitz High School