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Click here or scroll down to respond to this candidateCandidate's Name
Claims AdjusterU.S. Citizen, Street Address years old, Driving license U452-0648-5292Street Address N Western Ave, ChicagoIllinois, United States, Street Address
PHONE NUMBER AVAILABLEEMAIL AVAILABLEResults-driven Claims Adjuster with 8 years of experience in the insurance industry. Skilled in managing and training new employees to ensure efficient and accurate claims processing. Demonstrated leadership abilities and adaptability in fast-paced environments. Committed to delivering results and providing exceptional customer service.Employment historyJul, 2018 - Oct, 2023Claims SpecialistState Farm Mutual Insurance Company at Bloomington, IL Applied knowledge of policies, and insurance regulations when determining coverage, liability, & damages. Effectively managed work through task driven queues while multitasking in a fast-paced call center environment Trained and assisted with managing new employees during on boarding. Was a resource for my team if they had any questions while keeping all claim handling within policy and jurisdiction. Collaborate with legal and compliance teams to ensure claims handling complies with all applicable laws and regulations. Identify potential fraudulent claims and take appropriate action to mitigate losses for the company. Maintain a high level of customer satisfaction by promptly and effectively resolving customer inquiries and concerns. Conduct regular audits of claim files to ensure compliance with company policies and procedures Conduct thorough investigations to determine coverage, liability, and damages for each claim, ensuring accurate and fair settlement offers.Provide expert guidance and support to claims adjusters in complex and high-value claim cases, ensuring accurate assessments and appropriate settlements.Evaluate and analyze claim data to identify trends and opportunities for process improvement Employment historyAug, 2012 - May, 2018Registered NurseFresenius Medical Care at North Peoria, ILDirects and provides, in collaboration with direct and ancillary patient care staff, all aspects of the daily provision of safe and effective delivery of chronic hemodialysis therapy to assigned patients. Administers medications as prescribed.Ensures physician orders for assigned patients are entered and acknowledged in the Medical Record. Initiates or assists with emergency response measures. Delegates appropriate tasks to direct patient care staff. Promotes infection control.Monitors patient care staff for appropriate techniques. Checks availability of adequate emergency equipment and supplies as assigned. Ensures patient awareness related to transplant and treatment modality options. Assists with medication tracking and inventory as assigned. Assisted with other clinics in central Illinois.Ensures compliance with all regulatory requirements and standards related to patient care and safety. Participates in quality improvement initiatives and assists in the development and implementation of evidence-based practices to improve patient outcomes.Coordinates and facilitates the training of new nurses and technicians in the clinic, ensuring that they have the necessary skills and knowledge to provide quality patient care.Maintains accurate and up-to-date patient records, including medical histories, symptoms, and treatments provided. Collaborates with other healthcare professionals to develop and implement individualized care plans for patients. Collaborates with interdisciplinary healthcare team members to develop and implement individualized care plans for patients. Assesses and recognizes potential risks or complications during chronic hemodialysis therapy and takes appropriate action. Employment historyFeb, 2008 - Aug, 2013Guest Service Team LeaderTarget at Peoria, ILDemonstrate a service culture that prioritizes the guest service experience. Model, train and coach expectations to deliver the service standard.Understand sales goals, plan and execute daily/weekly workload to deliver on department and store sales goals and guest engagement, including: merchandising, pricing, transitions, revisions, sales plans, sampling, promotions and price change. Enable a consistent experience for our guests by ensuring product is zoned, in stock, available, accurately priced and signed on the sales floor.Be an expert of operations, accuracy, process and efficiency. Oversee execution of processes in inbound, outbound, replenishment, inventory accuracy, presentation, pricing and promotional signing processes for select GM areas of the store. Create a scheduling plan in partnership with your ETL based off of monthly and weekly business workload and guest traffic. Expect and enable team members to stay up-to-date on relevant trends and products. Establish clear goals and expectations and hold team members accountable to expectations. Lead and coach the team to ensure accuracy and efficiency in all processes. Work a schedule that aligns to guest and business needs. Lead a team that provides a guest-ready and in-stock sales floor in order to meet the needs of the guest. Assess Fulfillment business and make decisions to help teams fulfill all guest orders accurately and efficiently. Demonstrate a commitment to diversity, equity, and inclusion through continuous development, modeling inclusive behaviors, and proactively managing bias.Demonstrate a culture of ethical conduct, safety and compliance; lead and hold the team accountable to work in the same way. Address store needs (emergency, regulatory visits, etc. Develop and implement training programs to educate team members on the importance of exceptional guest service and provide ongoing coaching and feedback to improve performance and meet company standards. Maintain a positive and inclusive work environment by fostering teamwork and collaboration among team members Collaborate with other departments to ensure the smooth running of operations and to provide excellent service to guests. Lead the team in monitoring and maintaining inventory accuracy by conducting regular audits and reconciliations. Monitor and analyze guest feedback and reviews to identify areas for improvement and implement strategies to enhance the guest service experience.Analyze customer feedback and data to identify areas of improvement and implement strategies to enhance the guest service experience.Develop and implement strategies to improve the efficiency of the pick, pack, and ship fulfillment process in order to meet guest delivery expectations and reduce order processing time. Employment historyJun, 2000 - Sep, 2007Head LifeguardLincoln Park District at Lincoln, ILManage and trained16 lifeguards, which develop leadership skills, provide experience handling administrative issues. Examine injured persons/administered first aid or cardiopulmonary resuscitation, if necessary. Supervise pool maintenance, CPR, AED-PR, first-aid, record keeping, and customer service. Obtain and maintain required certifications.Maintain all first-aid and medical emergency equipment. Position lifeguard team members throughout the amusement park and oversee general lifeguard operations. Ensure first-rate lifeguard performance during pool hours, providing maximum safety and customer satisfaction. Work seasonally and given leadership accountability for supervising lifeguards and overseeing water activities and lessons at the pool. Provide first aid for patrons in a large facility filling out incident and accident reports when necessary. Ensure compliance with all safety regulations and protocols to maintain a safe environment for patrons and staff. Develop and implement a comprehensive training program for lifeguards, focusing on skills development, emergency response, and customer service.Develop and implement lifeguard training programs to enhance lifeguard skills and knowledge. Organize and oversee regular lifeguard training drills to ensure preparedness for emergency situations. Develop and implement a plan to promote water safety awareness to the community, including organizing and conducting educational programs and events.Develop and implement a mentoring program for lifeguards to foster personal and professional growth. Supervise the acquisition and maintenance of all necessary first-aid and medical emergency equipment to ensure maximum preparedness in case of emergencies.EducationOct, 2008 - Apr, 2012Associates in NursingIllinois Central College at East Peoria, ILApr, 2006 - Jul, 2007Trade School - CertificationMidwest Technical Institute at East Peoria, ILAug, 2000 - May, 2004High school diplomaOlympia High School at Stanford, ILSkillsInvestigating EvaluatingNegotiating Settling claimsExperienced ExperiencedSkillful ExperiencedSkillsApplying knowledge of policies Insurance regulations Determining coverage Determining liabilityDetermining damages Contacting customersManaging work MultitaskingSupporting customers Performing ongoing collection and analysis of patient data Adjusting treatment plan Notifying healthcare team members Collaborating with healthcare team members Assessing patient care needs Collaborating with patient care staff Providing safe and effective delivery of hemodialysis therapy Administering medications Ensuring correct laboratory procedures Rescheduling missed or insufficient laboratory collections Entering physician orders Acknowledging physician orders Initiating emergency response measures Delegating tasks to patient care staff Monitoring patient care staff Promoting infection control Ensuring patient awareness of transplant and treatment options Referring patients for education and counseling Checking availability of emergency equipment and supplies Assisting with medication tracking and inventory Demonstrating a service culture Modeling expectations Training expectationsUnderstanding sales goals Planning and executing workload Merchandising PricingTransitions RevisionsSkillful SkillfulExperienced ExperiencedExperienced ExperiencedSkillful ExperiencedExperienced SkillfulExperienced ExperiencedExperienced ExperiencedExperienced ExperiencedExperienced ExperiencedExperienced ExperiencedExperienced ExperiencedExperienced ExperiencedExperienced ExperiencedExperienced SkillfulExperienced ExperiencedSkillful SkillfulExperienced ExperiencedBeginner ExperiencedExperienced ExperiencedSkillsSales plans SamplingPromotions Price changeEnabling a consistent guest experience Ensuring product availability Leading pick, pack, and ship fulfillment Being an expert in operations Overseeing execution of processes Creating a scheduling plan Staying up-to-date on trends and products Establishing clear goals and expectations Holding team members accountable Leading and coaching the team Working a schedule aligned to guest and business needs Assessing fulfillment business Demonstrating commitment to diversity, equity, and inclusion Demonstrating ethical conduct, safety, and compliance Addressing store needs Managing and training lifeguards Supervising pool maintenance Providing first aid and CPR Maintaining certifications Maintaining first-aid and medical emergency equipment Overseeing lifeguard operations Ensuring lifeguard performance Supervising water activities and lessons Filling out incident and accident reports Exercising constant alertness Making precise decisions Examine injured individuals Administering first aid Clerical experience Organizational skillsInsurance verification FilingMedical terminology ICD-10Experienced ExperiencedExperienced ExperiencedExperienced ExperiencedExperienced ExperiencedExperienced ExperiencedExperienced ExperiencedSkillful ExperiencedSkillful SkillfulExperienced ExperiencedExperienced ExperiencedExperienced ExperiencedExperienced ExperiencedExperienced ExperiencedExperienced ExperiencedExperienced ExperiencedExperienced ExperiencedExperienced ExperiencedSkillfulExperienced SkillfulSkillsICD coding CPT codingMedical documentation Medical recordsHIPAA Auto estimatingLeadership Risk assessmentProcess improvement Team managementClaims processing Customer serviceData analysis Leadership developmentProcess optimization Team buildingStrategic planning Customer satisfactionRisk management Analyzing dataInternshipsMar, 2007 - Jul, 2007Medical AssistantJoslyns Diabetes Center at Peoria, IllinoisAssist patients with managing their diabetes through medication administration and lifestyle changes. Assist healthcare providers in patient examinations and procedures. Assist healthcare providers in conducting medical tests and procedures to diagnose and treat patients with diabetes. Educate patients on proper diabetes management techniques and lifestyle changes. Provide education and support to patients on diabetes management strategies. Ensure patient privacy and confidentiality are maintained at all times. Assist in the development and implementation of new diabetes management programs and initiatives. Assist in the coordination and scheduling of medical appointments for patients with diabetes. Skillful SkillfulExperienced ExperiencedExperienced SkillfulExperienced ExperiencedExperienced ExperiencedExperienced ExperiencedSkillfulExperienced ExperiencedSkillful ExperiencedExperienced SkillfulInternshipsRegistered NurseOSF Medical Groul at Peoria, IllinoisCollaborated with interdisciplinary team members to develop and implement patient care plans. Developed and implemented evidence-based nursing interventions to improve patient outcomes. Continuously updated knowledge and skills in order to provide the best patient care possible. Coordinated with pharmacy to ensure timely delivery of medications for patients Provided emotional support and empathy to patients and their families during difficult times. Assisted in the development and implementation of quality improvement initiatives to enhance patient care outcomes. Ensured compliance with all applicable state and federal regulations related to patient care and safety. Collaborate with other healthcare professionals, such as doctors and therapists, to coordinate patient care and ensure comprehensive treatment plans.Collaborate with healthcare providers to identify and implement best practices in patient care. Assist in the preparation and administration of medications to patients. Provide nursing care and treatment to patients according to established protocols and procedures. Educate patients and their families about health conditions, medications, and treatment options. Assist in patient education by providing information, resources, and support to help patients and their families understand their healthcare options and make informed decisions.LanguagesEnglish GermanHobbiesI love to travel and experience different cultures first hand. ReferencesJames JonesEMAIL AVAILABLE PHONE NUMBER AVAILABLEJonathan MinterEMAIL AVAILABLE PHONE NUMBER AVAILABLEJason GillEMAIL AVAILABLE PHONE NUMBER AVAILABLELogan HallEMAIL AVAILABLE PHONE NUMBER AVAILABLEHighly proficient NoviceState Farm Insurance State Farm InsuranceFresenius Kidney Care Target |
