Summary
Overview
Work History
Education
Skills
Accomplishments
Floral Crafter
Additional Information
Timeline
Generic

Paula Christmas

Southfield,MI

Summary




Analytical problem-solver with excellent communication skills. Effective at interviewing claimants, compiling records and documenting findings. Well-versed in insurance policies, practices and standards.


Gifted in working with stressed, confused and upset individuals in need of benefits information and supportive guidance to navigate Lexis Nexis systems. Effective at operating within Auto regulations and Cost Containment and Auto Physical damage department guidelines to manage telephone calls, emails, letters and in-person requests for assistance. Organized and dependable candidate successful at managing multiple priorities with a positive attitude. Willingness to take on added responsibilities to meet team goals.

Overview

19
19
years of professional experience

Work History

Claims Representative

AAA Auto Club Group
11.2002 - 01.2021
  • Analyzed and addressed escalated claims to resolve issues quickly.
  • Worked productively in fast-moving work environment to process large volumes of claims.
  • Researched and analyzed complex claims to determine next steps and possible outcomes.
  • Updated claims system to track claim status and provide relevant information to other department.
  • Developed in-depth understanding of insurance policies and procedures to give accurate recommendations to suit clients' needs.
  • Followed up with customers on unresolved issues.
  • Collaborated with internal departments and external vendors to achieve fast resolution of claims.
  • Maintained accurate and up-to-date records of claim information for future reference.
  • Monitored and managed claim expenses to control costs and maximize profitability.
  • Maintained strong knowledge of basic medical terminology to better understand services and procedures.
  • Verified client information by analyzing existing evidence on file.
  • Generated, posted and attached information to claim files.
  • Carried out administrative tasks by communicating with clients, distributing mail, and scanning documents.
  • Prepared insurance claim forms or related documents and reviewed for completeness.
  • Maintained confidentiality of patient finances, records, and health statuses.
  • Made contact with insurance carriers to discuss policies and individual patient benefits.
  • Assured timely verification of insurance benefits prior to patient procedures or appointments.
  • Coordinated with contracting department to resolve payer issues.

Claim Analyst

AAA Auto Club Group
11.2001 - 01.2021
  • Maintained strict confidentiality with all personal data as per company guidelines.
  • Viewed reports regularly to make sure processing was conducted efficiently.
  • Interacted with clients and employees, which helped cultivate positive working relationships.
  • Identified key areas not performing well and implemented effective, new processes.
  • Delivered exceptional customer service to policyholders by communicating important information and patiently listening to issues.
  • Examined claims forms and other records to determine insurance coverage.
  • Read over insurance policies to ascertain levels of coverage and determine whether claims would receive approvals or denials.
  • Conducted day-to-day administrative tasks to maintain information files and process paperwork.
  • Identified insurance coverage limitations with thorough examinations of claims documentation and related records.
  • Researched claims and incident information to deliver solutions and resolve problems.
  • Reviewed police reports, medical treatment records, and physical property damage to determine extent of liability.
  • Reviewed and analyzed suspicious and potentially fraudulent insurance claims.
  • Organized, planned and documented materials for car travel and subrogation claims.
  • Evaluated original investigation reports and documents to resolve secondary concerns.
  • Determined liability outlined in coverage and assessed documentation such from police and healthcare providers to understand damages incurred.
  • Maintained claims data in Policy systems.
  • Directed claims negotiations within allowable limit of $2,500 and supported successful litigations for advanced issues.
  • Handled inquiry calls from customers and other stakeholders about reimburstment processes.

Education

No Degree -

Oakland University
Rochester, MI

Skills

  • Account Management Expertise
  • Insurance Industry Experience
  • Negotiation
  • Social Perceptiveness

Accomplishments

    Retired Register Nurse

Floral Crafter

Create floral designs for any occasion or event

Additional Information

Retired Register Nurse

Timeline

Claims Representative

AAA Auto Club Group
11.2002 - 01.2021

Claim Analyst

AAA Auto Club Group
11.2001 - 01.2021

No Degree -

Oakland University

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Paula Christmas