Shemekia Perryman
Mobile,AL
Summary
Ethical Claims Adjuster with excellent customer service skills to take on multiple cases while meeting strict deadlines. Adept at determining the level of loss for claims cases and deciding on fair compensation for clients.
Overview
20
20
years of professional experience
1
1
Certification
Work History
Customer Service Representative
Sedgwick
03.2024 - Current
- Managed high-stress situations effectively, maintaining professionalism under pressure while resolving disputes or conflicts.
- Resolved customer complaints with empathy, resulting in increased loyalty and repeat business.
- Handled escalated calls efficiently, finding satisfactory resolutions for both customers and the company alike.
- Exceeded performance metrics consistently, earning recognition as a top performer within the team.
- Maintained standards of quality, timeliness, productivity and customer service.
Independent Adjuster
AUTO EXPRESS FLEX VIRTUAL ADJUSTER, CNC,State Farm
06.2020 - 02.2024
- Review Explanation of Benefits from primary insurance to determine obligation under our policy. Issue payment to medical providers.
- Provided excellent customer service to resolve customer complaints in a timely manner.
- Examine claim submissions and documentation to confirm coverage, assess claims, compare data, and certificates of insurance to ascertain completeness and validity of claims.
- Sends initial contact letter which also explains which benefits are available, create denial letters based on policy.
- Handle all inquiries from claimant, insured, or medical provider regarding the status of a claim.
- Proactive work to resolve claims as expeditiously as possible; decisions are made based on authority levels,policies, and documented procedures.
- Calculate reimbursement of benefits according to the schedule of coverage, updating reserves, and thoroughly inputting the necessary details in the claims system.
Resident
AUTO EXPRESS FLEX VIRTUAL ADJUSTER, EBERL, State Farm
01.2018 - 02.2020
- Manages, handles, and resolves a variety of express, core and total loss claims with a focus on total loss across State
- Communicates with policyholders, witnesses, and claimants to gather information regarding claims and refers tasks to auxiliary resources as necessary.
- Investigates and evaluates coverage, liability, and damages. Review new mail, police reports, and default calendars.
- Uses internet resources and State Farm contracted vendors for pricing and/or validation of inventoried items.
- Updates files and provides comprehensive reports as required. Identifies and recommends referral of potentially fraudulent claims to the SIU.
MEDICAL INSURANCE SPECIALIST
THE INFIRMARY HEALTH SYSTEMS
02.2005 - 09.2017
- Made contact with insurance carriers to discuss policies and dual patients benefits
- Maintained user confidence and protected operations by keeping information confidential
- Coordinated claims case management with physicians offices and other health care professionals
- Worked with multiple departments to solve claim problems, improve operations and provide exceptional customer service
- Provided support services including troubleshooting issues related to use of Epic applications.
- Maintained up-to-date knowledge of changes in state and federal laws pertaining to health care coverage.
- Stayed current on HIPAA regulations, benefits claims processing, medical terminology and other procedures.
- Displayed strong telephone etiquette, effectively handling difficult calls.
- Approached customers and engaged in conversation through use of effective interpersonal and people skills.
Education
Associate of Applied Science - Business Administration
Rasmussen College
04-2019
Diploma - Medical Billing and Coding
VIRGINIA COLLEGE
01-2005
High School - General Studies
John S Shaw High School
05-1998
Skills
- Customer Service
- Problem-solving abilities
- Active Listening
- Critical Thinking
- Customer Relations
Certification
- State Farm Policy, Estimatics & Auto
- Symbility
- CCC
- Navigator
- XactAnalysis
- ECS
Timeline
Customer Service Representative
Sedgwick
03.2024 - Current
Independent Adjuster
AUTO EXPRESS FLEX VIRTUAL ADJUSTER, CNC,State Farm
06.2020 - 02.2024
Resident
AUTO EXPRESS FLEX VIRTUAL ADJUSTER, EBERL, State Farm
01.2018 - 02.2020
MEDICAL INSURANCE SPECIALIST
THE INFIRMARY HEALTH SYSTEMS
02.2005 - 09.2017
Associate of Applied Science - Business Administration
Rasmussen College
Diploma - Medical Billing and Coding
VIRGINIA COLLEGE
High School - General Studies
John S Shaw High School
Similar Profiles
Jose PerezJose Perez
ERISA Specialist/Administrative Assistant at SedgwickERISA Specialist/Administrative Assistant at Sedgwick
Danyale M. MayhueDanyale M. Mayhue
LOA Coordinator Examiner (Remote Worker) at SedgwickLOA Coordinator Examiner (Remote Worker) at Sedgwick
BRIDGET JACKSONBRIDGET JACKSON
Patient Care Coordinator at SedgwickPatient Care Coordinator at Sedgwick
Ambrea MasseyAmbrea Massey
Accommodation Claims Specialists at SedgwickAccommodation Claims Specialists at Sedgwick
LAUREN LITTLELAUREN LITTLE
Team Member at Smoothie KingTeam Member at Smoothie King