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Candidate's Name
Claims SpecialistPonder, Texas, United StatesPHONE NUMBER AVAILABLEEMAIL AVAILABLEWORK EXPERIENCEJanuary 2024-CurrentClaims SpecialistState FarmRichardson, Texas, United States Reviewed incoming documentation for completeness prior to processing a claim. Provided customer service to policyholders and claimants by answering their questions, resolving disputes, and explaining coverage details. Analyzed claims to determine extent of company's liability and made approval or denial decisions in accordance with policy provisions. Drafted letters of denial or notification of payment in response to claimant inquiries. Utilized appropriate job aids, knowledge and tools to process initial reception of claims. Ensured timely filing of claims reports with regulatory agencies as required by law. Analyzed claims data to determine appropriate resolution of cases according to company policies and procedures. Maintained accurate records of all claim activities in the database system. Utilized problem-solving skills to investigate complex insurance claims with multiple factors. Conducted timely reviews of claims to ensure accuracy and completeness of documentation. Secured statements from parties involved in auto accidents to determine liability. Collaborated with other departments, customers and insurance companies to resolve claims in an efficient and timely manner. Obtained and reviewed vehicle photos and accident scene photos to aid in determining liability. Entered insurance- and claims-related information into database systems. Provided customer service, such as limited instructions on proceeding with claims and referrals to auto repair facilities and local contractors.November 2016-November 2022Emergency Management Specialist/SME/LEAD/Tech RepFederal Emergency Management AgencyDenton, Texas, United StatesCoordinated Disaster Response through initiating Registration Intake upon activation of a Major Disaster Declaration for Individual Assistance.Orchestrated Inspection Assignments by processing and routing requests to Inspection Services to set appointments and follow up, streamlining the Inspection process and maximizing Inspections completed and applicants assisted.Managed Disaster Recovery by exercising stellar time management skills and processed Applications submitted for federal grants covering Home Repair/Personal Property/Transportation, Temporary Housing, Temporary Shelter Asst. etc. as outlined by FEMA Guidance.Collaborated with Supervisors and Trainers while serving as a Subject Matter Expert, Lead and Tech Rep during Training Sessions in the following lines of business: Temporary Housing Asst Helpline, Appeals, Fema Manual Processing, FEMA Helpline I & II.Assisted with Quality Control, monitoring live calls on the COVID Funeral Asst Helpline and Processing to prepare and analyze assessments following disasters and emergencies. Developed and maintained critical training material to accurately provide record of updated FEMA Policy and necessary maintenance logs of updated processes and location of new applications.Attended all required meetings, trainings, briefings and workshops related to emergency management to learn new information in order to develop newknowledge, skills and abilities while establishing new working relationships within other departments, playing a key role in the utilization of safety and accuracy as required by FEMA.Completed extended Travel; Deployed in 2017 to Buffalo, New York to assist FEMA Surge Partners with increased disaster activity.Proposed alteration of emergency response procedures based on regulatory changes, technological changes and knowledge gained from outcomes of previous emergency situations.Reviewed forms and reports, conferring with management and users about format, distribution and purpose, identifying problems and recommending improvements.Documented findings of study and prepared recommendations for implementation of new systems, procedures, or organizational changes.August 2013-October 2016Client Services SpecialistTexas Workforce ResCareDenton, Texas, United StatesDetermined eligibility, maintained and completed all eligibility records for case files, including eligibility screenings and assessment of family needs.Performed mathematical calculations to determine household income and the parent's share of cost and processed the appropriate enrollment forms.Adhered to state and local policies and accurately determined eligibility based on confidential documentation. Discontinued services when necessary.Processed eligibility, case changes, drops, and transfers accurately within the required timeframe as established by funding sources.Managed a high volume of case files and data entry daily. Entered all data into The Workforce Information System of Texas (TWIST) and internal systems accurately and in the required timeframe. Completed case documentation in an objective and fact-based manner. Understood that records may be reviewed and used by other users of thestate database and professionals, including monitors, TWC and Workforce Solutions staff, fraud investigators, attorneys, service providers, and other professionals.Established rapport and credibility with customers and providers by providing excellent customer service in a professional and respectful manner.Contacted customers to gather necessary information and explain outcomes, and customer rights and responsibilities.Interpreted and communicated state and local policies and procedures to customers in an understandable manner.Educated new customers coming into program and offered solutions for other related issues customers might be facing - example; if they are not eligible, offer other alternatives.Communicated effectively and discontinued services when applicable. Attention to detail and a positive attitude. Produced content/copies and accurately edited documents. Provided back up support to team members. Completed Other duties and responsibilities as assigned. EDUCATION2023-2023Adjusters All Lines LicenseAdjusters Training InstituteDenton, Texas, United StatesInsurance Claims Adjuster School. Completed Coursework and obtained Texas ALL LINES Adjuster License. 2016-2016Emergency Manager CertificationCenter for Disaster PreparednessAnniston, Alabama, United StatesEmergency Manager School. FEMA Required courses completed and certification obtained.-1996GEDOklahoma City Community CollegeOklahoma City, Oklahoma, United StatesMay 1996GEDOklahoma City Community College, Oklahoma City, Ok January 1996High School DiplomaPutnam City West, Bethany, OklahomaSKILLSCustomer Support/Service Database Technology Insurance Claims Problem Solving Skills Disaster Recovery Emergency Management Emergency Response Quality Control Time Management Transportation Detail Oriented Communication Skills Data Entry Information Technology & Information Systems Mathematics Analysis Skills Case Management Conflict Resolution Data Quality Database Administration Financial Transactions Multitasking Microsoft SharePoint Documentation Writing Skills Regulatory Reports Legal Data Analysis Corporate Policies Record Keeping Insurance Federal Emergency Management Agency Federal Grants Property Maintenance Quality Monitoring Call Monitoring Regulations Emergency Procedures Conference Management Identify Issues Needs Assessment Funding Fraud Investigation Customer Training Content Development Editing Claims Processing Policy Analysis Administrative Skills Microsoft Product Family 10-key (Tenkey) Numeric Keypad Computer Skills Technical Training CERTIFICATIONSActive Adjuster License: ALL LINESHONORS & AWARDSDiamond CaseworkerMaintained highest level of processing metrics. Awarded Award and Bonus LANGUAGESEnglish - Fluent |
