Priscilla Glover
Gainesville,FL
Summary
Claims Adjuster with deep experience in confidential litigation claims. Superbly positioned to investigate, evaluate and settle Auto, Property & Casualty claims. Excellent abilities to decipher fraudulent activities, analyze data, confer with legal counsel and communicate with brokers to gain details for processing claims.
Overview
10
10
years of professional experience
Work History
Financial Specialist
UF Health Shands Hospital
Gainesville, fl
11.2020 - Current
- Obtain, update and verify insurance to ensure proper billing
- Calculate patient financial responsibility and provide estimates for co-pay obligations
- Executed financial assurance audits and implemented new control points and metrics to support business changes.
- Knowledge of commercial health insurance policies, and vast understanding of Medicare/Medicaid health and billing protocols
- Coordinate with third party payer insurance to obtain necessary authorizations/precertification’s for services being rendered
Insurance Service Analyst
Nationwide Mutual Insurance Company
Gainesville, fl
09.2018 - 11.2020
- Followed appropriate procedures to approve and process reinstatement applications, conversions, and policy coverage changes within guidelines
- Identified overdue payments, reported collection activity, address client inquires and negotiated repayment plans
- Applied insurance knowledge to counsel clients on foundational/moderate billing, credit and premium changes
- Worked with RCPS (Root Cause Problem Solving) to research and create strategies to improve productivity, reduce cost and promote efficiency for all employees within company.
Claims Representative
Nationwide Mutual Insurance Company
01.2018 - 09.2018
- Conducted and investigated claims, interpreted laws and regulations, rendered insurance decisions from onset to closing
- Gathered initial claim information and coached clients/claimants throughout the claim process.
- Examined reports, accounts, and evidence to determine integrity and accuracy of information.
- Reviewed police reports, medical treatment records, and physical property damage to determine extent of liability.
- Negotiated with policyholders and claimants to reach mutually satisfactory resolutions.
Rehabilitation therapist
State of Florida Tacachale
11.2016 - 01.2018
- Worked effectively with an interdisciplinary team and consistently raised team morale
- Executed and complied with policies regarding patient admission, care and records to maintain standards of excellence for patients and families.
- Consulted with interdisciplinary teams to enhance coordination of care, establish medical clearance and determine optimal timing of further interventions.
- Determined existing problems and evaluated individual needs for achieving independence in daily living, in acquiring communication skills and/or obtaining suitable employment
- Developed individualized plans with each client to help them achieve their appropriate goal regarding college or vocational assistance, job placement services, rehabilitation engineering services, etc
- Managed personnel resources for 13+ clients.
Behavioral Program Specialist
State Of Florida Tacachale
01.2014 - 01.2016
- Oversaw 10+ employees by assigning work, reviewing progress and assessing performance
- Daily and consistently implements approved and scheduled active programs for residents to include, but not limited to areas of community awareness and vocational/prevocational skills, ensuring the residents safety and privacy
- Accurately document resident information including behavioral and vital records.
- Designed individual education plans to encourage patient growth according to different learning abilities and needs.
Education
Claims Adjuster License - 6-20 All Lines Claims Adjuster
State of Florida
02.2023
A.S - Psychology
Santa Fe College
12.2017
Diploma - undefined
Eastside high school
06.2012
Skills
- Issue Diagnosis/resolution
- Proficient in all Microsoft Programs
- Proficient in PeopleSoft & Epic systems
- Claims Negotiation
- Problem Solving
- Cost Reduction & Waste Elimination
- Property Adjusting
- Proficient in Xactimate/Symbolity
- Actuarial Science
- Claims File Management Processes
- Report Writing
- Data Analysis
Timeline
Financial Specialist
UF Health Shands Hospital
11.2020 - Current
Insurance Service Analyst
Nationwide Mutual Insurance Company
09.2018 - 11.2020
Claims Representative
Nationwide Mutual Insurance Company
01.2018 - 09.2018
Rehabilitation therapist
State of Florida Tacachale
11.2016 - 01.2018
Behavioral Program Specialist
State Of Florida Tacachale
01.2014 - 01.2016
Claims Adjuster License - 6-20 All Lines Claims Adjuster
State of Florida
A.S - Psychology
Santa Fe College
Diploma - undefined
Eastside high school