Experience

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  Cox communications

  Jan 2010 - Nov 2011

  Tech support/customer support

  •Keyed all work orders, billing, adjustments, updates to customer information, and account documentation.•Provided product knowledge, installation service changes, disconnects, trouble calls, updates to customer information, credit checks, and payments.•Responded to customer service requests by prioritizing and dispatching work orders to installation and/or service technicians.•Ensured daily routes meet drive time, on-time guarantee, productivity and skill set goals.•Monitored technician’s work order status and adjusts throughout the day. Show less

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  Adt

  Nov 2011 - Jul 2013

  Technical customer service representative

  • Resolves customer reprogramming needs and concerns by handling inbound and outbound calls.• Communicate with field services, close and reschedule jobs, and determine liability and coverage• Provides support to customers and resolves billing concerns • Supports tier 1 panel service tickets and programming requests from inbound phone calls• Processes data changes received via mail, fax, phone or internal ticket on Informix and Mastermind for all dealer account databases, as well as a limited number of ADT account databases. • Supports false alarm research and damage claims and provide support for other data cleanup projects.• Review all financial documents and inquires. Resolve all order appraisal Show less

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  Unitedhealth group

  Jul 2013 - May 2014

  Claims/benefits specialist

  • Answers incoming calls, review appeal status and overrides for appeals• Obtain verbal authorizations and request detailed clinical information from prescribers and providers• Review Billing/ICD9 Codes/DUR/Rejection reports/error messages for claim errors• Evaluate medical and auto claims for potential fraud• Prior Authorizations relevant and or including: Pharmacy/Rejections, Surgery Claims, Medical/Auto Claims, Procedures, Long Term Care and additional request• Explanation of Benefits and or eligibility referencing members/providers concerns/complaints• Document proper files for claims and collect relevant documents to set up new claims for processing Show less

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  Cigna-healthspring

  May 2014 - Nov 2015

  Benefits/claims expert

  • Evaluate Medical/Auto claims to ensure validity, negotiate settlement value and determine liability. • Educate and explain policy procedures and claims process to the insured or provider. • Service customers on all medical platforms and products as well as pharmacy, dental, and behavioral health as needed.• Able to stay up to date with insurance product knowledge including Medicare/Medicaid guidelines for processing claims and maintain all necessary licensing to handle claims products and appraisals • Pull Claim reports and analyzes data and trends including, responding to medical/auto claim inquires request from internal and external customers. • Explain appeal process and identify ways to resolve appeals in a timely manner• Process pharmacy overrides and explains benefits in RxClaims.• Explain prescription coverage, denials, and contact physicians or pharmacies for coverage determination and if prior authorization is needed for medication. Show less

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  Pilot catastrophe service

  Nov 2015 - now

  • Reviewed owner transfer paperwork and documentations for owner retained settlements to insure timely closure• Handle all office claims disputes by research and appraisal.• Mitigating storage charges by coordinating salvage pick up.• Handle all subrogation demands from all carriers.• Evaluated all insurance procedures and analyzed damages to determine coverage• Coordinated rental with rental vendors and customers to determine cause of loss• Review all estimates with customers and clients and coordinate re-inspection• Handle all subrogation demands from other carriers Show less Promptly and appropriately developed the file to provide an accurate and timely investigation and loss analysis.• Adhered to all statutory and regulatory fair claims practices.• Recognized and identified potential fraudulent claims.• Developed and maintained strong business relationships with internal and external customers.• Served as a technical resource to lesser experienced Adjusters.• Contact injured parties and legal representatives to negotiate final settlement for claims.• Identified and collected evidence and determined its value to a specific claim.• Set and adjusted claim reserves as needed.• Reviewed files daily and update claim status.• Prepared denials and reservation of right letters.• Reviewed medical billing to ensure that they are casually related to the injury.• Establish liability claims and total loss Show less

  • Claims Adjuster

    Aug 2016 - now

  • Claims Adjuster

    Nov 2015 - now