Claims Representative

Published on December 2017 | Categories: Documents | Downloads: 39 | Comments: 0 | Views: 417
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LeToya Wallace 509 Scarsdale Drive Columbia, South Carolina 29203 [email protected] 803-260-4419/803-754-1785 OBJECTIVE Seeking a position that allows for application of knowledge and experience in mu lti-faceted, complex activities and opportunity for personal and professional co ntribution within the claims environment. KEY COMPETENCIES Mediations Medical Terminology Negotiations Strategic Planning Litigation Management Account Management Conflict Management Project Management Standard Policy & Procedures PROFESSIONAL EXPERIENCE Nationwide Insurance 2005 - Present Nationwide is one of the largest insurance and financial services companies in t he world, with more than $148 billion in statutory assets. The core businesses i nclude: domestic property and casualty insurance, life insurance and retirement savings, asset management, and strategic investments. Nationwide Mutual Insurance/ North Carolina, South Carolina 2005 - Present Commercial Claims Adjuster/ Litigation Representative for North Carolina and So uth Carolina Responsible for strategic direction for new employees and progress. Direct leade rship of employee activities with respect to Financial Planning. Primarily inves tigates basic commercial property damage, material damage and/or bodily injury c laims. * Determines proper coverage, investigate, negotiate, and equitably settle claim s as assigned. * Documents all decisions, correspondence, reports and discussions that occur du ring the investigation. * Establishes and authorizes reserves and claims payments within the delegated a uthority. * Thorough understanding of bodily injury dynamics. * Negotiates Settlements with Attorneys. Project Manager 2009-2010 Coordinated with management and technical personnel to analyze and document pros pective business process methods and techniques. Negotiated contract negotiation s and vendor management. * Defined project scope and requirements. * Created work plan and budget, assigned tasks to all parties involved. * Monitored performance of work effort and taking corrective action when needed. Cardiology Care Group, Columbia, SC 2003 - 2004 This office was dedicated to the diagnosis and treatment of heart disease. Serv ices offered include consultation for patients to include financial management, scheduling, and coordination of care. Business Manager * Responsible to lead the daily operation of the office to include interviewing, hiring, and training employees; planning, assigning, and directing work; apprai

sing performance; rewarding and disciplining employees; addressing patient compl aints and resolving problems. * Developed job descriptions for medical practice staff. * Researched, analyzed, and monitored financial, technological, and demographic factors so that market opportunities may be maximized. * Evaluated billing and collection processes.

Palmetto Health Alliance 2000 - 2003 A global leader in bringing technology and engineering together to provide innov ative healthcare to patients. Owns and operates hospitals, clinics, and hospice facilities throughout the state. Patient Account Representative Corporate Trainer * Corresponded with insurance carriers and patients for immediate payment. * Provided duplicate bills, coordination of benefits, and medical records. * Prepared reports necessary to maintain acceptable levels of account receivable s. * Instructed training classes for employees on ICD9, CPT, and HCPCS codes EDUCATION Webster University, Masters of Business Administration Limestone College, Bachelor of Science in Business Administration/Management

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