Shauna Williams
Spring
Summary
Offering strong analytical skills and detail-oriented mindset, ready to learn and grow in claims examination. Contributes to understanding insurance policies and leveraging data analysis for effective decision-making. Ready to use and develop critical thinking and communication skills in a Senior Claims Adjuster role.
Overview
12
12
years of professional experience
Work History
Claims Examiner
New York Black Car Fund
12.2017 - Current
- 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.
- Participated in cross-functional team meetings to address organizational challenges related to claims management and develop solutions collaboratively.
- Reduced claim processing time by implementing efficient workflow strategies and prioritizing tasks effectively.
- Mitigated fraud risks by identifying suspicious patterns in claims data and escalating concerns to appropriate teams for further investigation.
- Negotiated settlements with claimants'' attorneys when needed, achieving favorable outcomes for both parties while minimizing costs.
- Maintained detailed records of all claims activities, ensuring compliance with regulatory requirements and company policies.
Senior Workers' Compensation Claims Adjuster
Chubb Insurance
12.2012 - 12.2017
- Examined claims forms and other records to determine insurance coverage.
- Delivered exceptional customer service to policyholders by communicating important information and patiently listening to issues.
- Identified insurance coverage limitations with thorough examinations of claims documentation and related records.
- 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.
- Analyzed information gathered by investigation and reported findings and recommendations.
- Documented information gathered in field and uploaded data to company database for efficient processing using Claim Vision and Risk Master.
Education
Associate of Science - Health Administration
University of Phoenix
Tempe, AZ12-2014
Skills
- Claims processing
- Verbal communication
- Data verification
- Disability claims process
- Microsoft Office Suite
- Decision-making
- Claims evaluation
- Payment processing
- Team leadership
- Claims investigation
- File and record management
- Coverage determination
- Relationship building
- Fraudulent claims investigation
Timeline
Claims Examiner
New York Black Car Fund
12.2017 - Current
Senior Workers' Compensation Claims Adjuster
Chubb Insurance
12.2012 - 12.2017
Associate of Science - Health Administration
University of Phoenix
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