Zeporia Mills
Rex,GA
Summary
Highly-motivated employee with desire to take on new challenges. Strong work ethic, adaptability, and exceptional interpersonal skills. Adept at working effectively unsupervised and quickly mastering new skills.
Overview
7
7
years of professional experience
1
1
Certification
Work History
Claim Specialist
MagMutual Insurance
Atlanta, GA
10.2022 - Current
- Reviewed incoming claims for accuracy and completeness in accordance with policy provisions.
- Identified potential fraud indicators and escalated to appropriate personnel for further investigation.
- Responded to inquiries from claimants, attorneys, medical providers. regarding the status of their claim.
- Maintained timely and accurate records of all claim activity.
- Investigated, evaluated, and negotiated settlements of assigned claims.
- Analyzed medical reports, bills, legal documents, or other information related to claims.
- Determined liability according to applicable laws and coverage provisions.
- Provided excellent customer service throughout the entire claims process.
- Developed effective relationships with customers through communication via phone or email.
- Ensured that all documentation was accurately entered into the system.
- Reviewed policies and procedures regularly to ensure they are up-to-date with industry standards.
- Resolved difficult issues promptly while maintaining a high level of professionalism.
- Advised claimants on available benefits under their policy coverage.
- Processed payments accurately according to established timelines.
- Determined liability, compensability, and benefits due on each claim.
- Supported efficient handling of complex claims and followed up on open, denied, or suspended claims to complete required line items.
- Processed claims for payment or forwarded to appropriate personnel for further investigation
- Reviewed and verified invoices for accuracy and completeness.
- Processed vendor invoices in a timely manner.
- Generated weekly check runs for approved invoices.
- Communicated effectively with vendors regarding billing inquiries or discrepancies.
Insurance Adjuster
Pilot Catastrophe Services
Mobile, AL
09.2017 - 10.2022
- Investigated insurance claims to determine coverage and liability.
- Analyzed claimant information to evaluate validity of claim.
- Calculated estimated costs for damages and losses.
- Maintained organized records of claim activity and related documents.
- Reviewed police reports, medical records, witness statements, and other evidence to assess damages.
- Prepared detailed written reports of findings to document investigation results.
- Informed claimants about the claims process and answered questions regarding policies.
- Ensured compliance with state regulations governing insurance industry practices.
- Processed paperwork associated with approved claims payments.
- Monitored claims activities to ensure timely resolution of disputes.
- Drafted correspondence to notify claimants about claim decisions.
- Performed data entry tasks into company systems for tracking purposes.
- Investigated properties, classified damages and created estimates outlining repair costs.
- Checked into questionable claims, interviewing agents and claimants to resolve errors and omissions.
- Verified liability extent with reviews of police reports, medical treatment histories and other records.
- Negotiated and settled claims according to information presented through reports, research, and data verification.
- Drafted statement of loss to summarize damages, payments and underlying policy coverage.
- Reviewed, evaluated and adjusted claims to promote fair and prompt settlement.
- Identified and obtained evidence to ascertain claim value.
- Completed required investigations on referred files within established timeframes.
- Communicated effectively with policyholders, providing updates and explaining claim processes.
- Interpreted insurance policy language to apply appropriate coverage.
- Utilized claim handling software to document and manage claim files efficiently.
Education
Insurance Adjuster License - Insurance Adjusting
Texas Adjuster Training Center
Irving, TX09-2018
Skills
- Problem-Solving
- Clerical Support
- Critical Thinking
- Troubleshooting
- Salesforce, Guidewire, Xactimate Software Proficiency
- Data Management
- Good Telephone Etiquette
- Computer Skills
Certification
- Texas Adjuster License # 2308282
- Florida Adjuster License #W449738
Timeline
Claim Specialist
MagMutual Insurance
10.2022 - Current
Insurance Adjuster
Pilot Catastrophe Services
09.2017 - 10.2022
- Texas Adjuster License # 2308282
- Florida Adjuster License #W449738
Insurance Adjuster License - Insurance Adjusting
Texas Adjuster Training Center
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