Toni Winters
Aubrey,TX
Summary
Accomplished Auto Insurance Adjuster with a proven track record in claims appraisal, policy interpretation, and settlement negotiations, bolstered by a versatile background in Human Resources and Medical Billing/Claims Administration. Combines hands-on expertise in auto claims investigations and damage assessments with strengths in recruitment, employee training, and HIPAA-compliant medical billing processes. Adept at driving efficiency through analytical problem-solving, regulatory compliance, and meticulous documentation, supported by proficiency in Microsoft Office Suite, data entry, and claims management systems.
Overview
15
15
years of professional experience
Work History
Claims Associate
State Farm
Richardson, TX
02.2021 - Current
- Expertly performed interviews and gathered detailed information from various sources, enabling the completion of in-depth field investigations that contributed to accurate claim assessments
- Demonstrate strong negotiation skills in settling claims based on thorough analysis of presented reports, research, and data verification, resulting in mutually agreeable resolutions for all parties involved
- Conduct comprehensive reviews, evaluations, and claims adjustments to ensure fair and prompt settlement while maintaining high customer satisfaction and trust
- Utilize solid decision-making abilities to recommend appropriate settlement offers and negotiate payment arrangements with claimants, ensuring a seamless and satisfactory resolution process
- Investigate and scrutinize questionable claims to determine whether payment authorization was warranted, contributing to the prevention of fraudulent activities and preserving company resources
- Review and analyze data to verify the validity of claims and determine appropriate case management actions, ultimately contributing to the overall efficiency and effectiveness of the claims department at State Farm
Medical Claims Examiner
NTT DATA Services
Plano, TX
05.2016 - 01.2021
- Demonstrated the capability to complete 75-90 claims daily
- Negotiated fair settlements with healthcare providers to minimize financial risk while ensuring adequate compensation for services rendered.
- Supported team members during periods of high workload, providing guidance on challenging cases or offering assistance when needed.
- Processed high volumes of medical claims accurately and efficiently under tight deadlines, ensuring prompt payment for services rendered.
- Researched and resolved complex medical claims issues to support timely processing.
- Maintained knowledge of benefits claim processing, claims principles, medical terminology, and procedures and HIPAA regulations.
- Contributed to cost savings by identifying areas of potential overbilling or underbilling in medical claims processing.
- Conducted thorough investigations of medical claims to ensure proper payment or denial.
- Self-motivated, with a strong sense of personal responsibility.
- Skilled at working independently and collaboratively in a team environment.
- Managed time efficiently in order to complete all tasks within deadlines.
Recruiter | Trainer
Self Opportunity, Inc
Lewisville, TX
09.2013 - 10.2016
- Developed and implement effective recruitment strategies to attract qualified candidates for local job opportunities across various industries, such as industrial, restaurant, and clerical positions
- Utilized job search engines and other resources to source and review potential candidates' resumes, ensuring that they meet the requirements for each specific position
- Applied critical thinking skills when creating and posting engaging job advertisements on social media platforms and other online channels, reaching a broad audience of potential candidates
- Conducted thorough interviews with candidates, in-person or over the phone, to assess their qualifications, experience, and overall fit for the role and company culture
- Screened resumes and performed pre-screening assessments to evaluate applicants' credentials and determine their suitability for the position
- Generated a targeted pool of candidates for various career opportunities by strategically placing advertisements, evaluating applicant qualifications, and conducting initial interviews and pre-screening assessments
Jewelry Sales Associate
Walmart
Ridgeland, MS
06.2010 - 02.2012
- Assisted customers in selecting and purchasing jewelry items by providing personalized recommendations based on their preferences and budget
- Ensured all jewelry pieces were correctly priced and displayed attractively to maximize sales potential
- Processed customer transactions efficiently by scanning items, applying discounts, and printing receipts
- Handled cash, counted change, and stored coupons to maintain a balanced and organized cash register
- Utilized creative merchandising techniques to showcase jewelry items in visually appealing displays that attracted customer attention and increased sales
Education
Associate Degree - Human Resources Development
Collin County Community College
Plano, TX12.2024
Diploma -
Yazoo City High School
MS05.2009
Skills
- Human Resource
- Recruitment
- Training
- Interviews
- Employee Management
- Microsoft Office Suite
- Organizational growth
- Claims processing proficiency
- Medical billing experience
- HIPAA compliance
- Professionalism and ethics
- Data entry proficiency
- Medical terminology
- Insurance claims processing
- Claims investigation
- Problem-solving
Areas Of Emphasis
- Claims Adjuster
- Strategic Planning
- Process Improvement
- Performance Evaluation
- Training & Development
- Employee Relations
- Compensation & Benefits
- Payroll & Interviewing
- Compliance Communication
- Employee Engagement
- Issue Resolution
- Problem Solving
- Relationship Management
- Claims Adjuster
- Medical Claims Processing
- Customer Service
- Leadership Skills
- HIPPA
Timeline
Claims Associate
State Farm
02.2021 - Current
Medical Claims Examiner
NTT DATA Services
05.2016 - 01.2021
Recruiter | Trainer
Self Opportunity, Inc
09.2013 - 10.2016
Jewelry Sales Associate
Walmart
06.2010 - 02.2012
Associate Degree - Human Resources Development
Collin County Community College
Diploma -
Yazoo City High School