Toni NELSON
Tampa
Summary
Thorough Adjuster with over 8 years of experience in the examiner and claims adjustment field. Strong knowledge of resolution procedures and claim settlement. Experienced handling irate and problematic customers. Organized and professional in stressful situations.
Overview
15
15
years of professional experience
Work History
PIP Response/Demand Examiner
GEICO
03.2021 - Current
- Demonstrated strong attention to detail while reviewing policy coverage information, ensuring accurate application of benefits according to contractual provisions.
- Enhanced claim resolution efficiency by thoroughly investigating and evaluating personal injury protection claims.
- Managed a diverse caseload of personal injury protection claims while maintaining organization and prioritization skills for optimal productivity.
- Maintained compliance by staying updated on industry changes, attending training sessions, and applying knowledge to daily work activities.
- 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.
Personal Injury Protection Adjuster
GEICO
04.2019 - 03.2021
- Provided superior customer service during high-stress situations by empathetically addressing concerns and resolving issues quickly.
- Reduced fraudulent claim payouts by diligently identifying potential fraud indicators and collaborating with the Special Investigation Unit.
- Managed a diverse caseload of personal injury protection claims while maintaining organization and prioritization skills for optimal productivity.
- Cultivated positive relationships with policyholders through proactive communication regarding claim status updates and anticipated timelines for resolution.
- Enhanced claim resolution efficiency by thoroughly investigating and evaluating personal injury protection claims.
- Demonstrated strong attention to detail while reviewing policy coverage information, ensuring accurate application of benefits according to contractual provisions.
- Consistently met or exceeded performance metrics in areas such as cycle time reduction, loss ratio improvement, and customer satisfaction ratings.
- Answered customer questions regarding deductibles.
Claims Service Specialist
GEICO
03.2016 - 04.2019
- Served as an empathetic liaison between clients experiencing loss events, helping them navigate a difficult time while providing excellent service.
- Analyzed data from closed claims cases to identify trends or patterns that could inform future decision-making processes around risk management strategies or policy adjustments.
- Utilized advanced software tools to efficiently manage claim assignments and track progress toward resolution.
- Conducted thorough investigations of complex claims to identify potential fraud or discrepancies.
- Improved customer satisfaction by efficiently resolving insurance claims and addressing inquiries.
- Followed up with customers on unresolved issues.
- Worked with claims adjusters and examiners to expedite processing in alignment with procedures.
Technical Claims Specialist
Coventry HealthCare
12.2009 - 05.2011
- Processed worker’s compensation claims and electronic work queues
- Review worker’s compensation claims to determine status and process accordingly with accuracy and completeness
- Examined information, including, but not limited to authorizations, payments, denials, coordination of benefits, and eligibility according to state and federal rules and regulations
- Interpret and process Appeals
- Investigated, analyzed and resolved outstanding issues to achieve customer satisfaction
Education
Associate of Applied Science - Business Administration
Hillsborough Community College
Tampa, FLSkills
- Empathy and sensitivity
- Claims handling
- Claims reports and documentation
- Claims investigations
- Evaluation of liability exposure
- Accuracy and precision
- Document review
- File management
- Deadline management
- Customer service
- Problem-solving abilities
- Proficient in Microsoft Offices
- Multitasking Abilities
Accomplishments
- Collaborated with PIP Litigation team on numerous projects to achieve and maintain top closing ratios.
Timeline
PIP Response/Demand Examiner
GEICO
03.2021 - Current
Personal Injury Protection Adjuster
GEICO
04.2019 - 03.2021
Claims Service Specialist
GEICO
03.2016 - 04.2019
Technical Claims Specialist
Coventry HealthCare
12.2009 - 05.2011
Associate of Applied Science - Business Administration
Hillsborough Community College
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