Teresa Oden
NEW ALBANY,OH
Summary
Skilled Claims Adjuster with a proven track record at One80 Intermediaries, excelling in customer service and claims file management. Demonstrated ability to improve processes and efficiently resolve claims, ensuring compliance and high-quality service. Expert in insurance regulations with a knack for critical thinking and empathy, achieving a 95% customer satisfaction rate.
Overview
7
7
years of professional experience
1
1
Certification
Work History
Claims Adjuster
One80 Intermediaries
Dublin, Ohio
05.2022 - Current
- Developed relationships with dealers, servicers, and customers in order to ensure prompt service when necessary.
- Utilized claim handling software to document and manage claim files efficiently.
- Interviewed servicers and customers to determine pertinent claim information.
- Investigated insurance claims, reviewed coverage and liability, prepared reports, and recommended payment or denial of claims.
- Adhered strictly to departmental guidelines, and ensured all activities complied with applicable state laws.
- Worked collaboratively with team members across multiple departments; identified areas where processes could be improved.
- Worked closely with repair facilities and contractors to ensure quality repairs for policyholders.
- Assisted colleagues with difficult cases; provided guidance regarding complex issues or scenarios.
- Interpreted insurance policy language to apply for appropriate coverage.
- Input claim information and payments into the company database.
- Ensured timely follow-up on all open matters, and kept clients informed regarding status updates.
Disability Claims Adjudicator
Ohio Opportunity for Disability
Columbus, OH
05.2021 - 03.2022
- Delivered exceptional customer service to clients by communicating information and actively listening to concerns.
- Conducted initial review of disability claims to assess eligibility for benefits.
- Researched relevant laws, regulations, policies, and procedures related to disability determinations.
- Collaborated with medical professionals to obtain additional information about claimants' disabilities.
- Reviewed medical records and other documentation submitted in support of a claim.
- Checked into questionable claims, interviewing agents and claimants to resolve errors and omissions.
- Assessed claimants' functional capacity through interviews, observations, and other methods.
- Ensured compliance with applicable federal and state regulations governing the adjudication process.
- Participated in training sessions designed to update staff on changes in policy or procedure.
- Performed quality assurance checks on completed cases before submitting them for supervisors to review.
- Evaluated claimant's ability to perform job-related duties based on evidence provided.
- Analyzed test results and physician statements to determine the severity of disability.
- Created detailed reports documenting all aspects of each case including findings, decisions, and recommendations.
- Managed time effectively to ensure tasks were completed on schedule and deadlines were met.
Verification Specialist
Health Management Systems, HMS
Westerville, Ohio
10.2017 - 04.2021
- Performed verification of customer accounts and ensured data accuracy.
- Investigated discrepancies in customer accounts to determine root cause and resolution.
- Checked documentation for appropriate coding, catching errors, and making revisions.
- Updated patient accounts with insurance verification information to ensure accurate billing.
- Researched and evaluated customer information for compliance with internal policies and procedures.
- Used computers or specified forms to compile, record, and code results or data from interviews or surveys.
- Maintained up-to-date knowledge of insurance policies, including Medicare and Medicaid.
- Participated in audits and quality assurance activities related to insurance verification.
- Accessed third-party insurance databases to identify coverage of benefits.
- Communicated with the insurance carrier, the patient, and a third party or employer to verify the patient's insurance benefits.
- Called insurance companies to ascertain pertinent information regarding policies and payment benefits for patients.
- Analyzed and interpreted insurance coverage policies to determine patient eligibility for services.
- Verified patient insurance coverage, benefits, and service eligibility across multiple insurance platforms.
Education
MBA - Business Administration And Management
Franklin University
Columbus, OH05-2006
Skills
- Active listening
- Insurance regulations
- Customer service
- Liability assessment
- Critical thinking
- Claims file management processes
- Empathy and patience
- Time management
- Workflow management
- Verbal and written communication
- Claims processing
- Data entry
Affiliations
- Reading
- Exercising
- Traveling
- Listening to music
Certification
- Adjuster- DHS Texas/License Number: 3172051
References
References available upon request.
Timeline
Claims Adjuster
One80 Intermediaries
05.2022 - Current
Disability Claims Adjudicator
Ohio Opportunity for Disability
05.2021 - 03.2022
Verification Specialist
Health Management Systems, HMS
10.2017 - 04.2021
MBA - Business Administration And Management
Franklin University
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