Jessica Walter Email & Phone Number

Spring, Texas, United States

• Analyzed first reports to determine the nature of loss, coverage provided, and scope of injury and damages. Conducted comprehensive coverage, liability and potential fraud investigations on reported claims.
• Established accurate and timely property damage reserves for claims, promptly documented all claim developments and determined final claim disposition through a thorough analysis (e.g., interviewed all pertinent.
• Aided in successful communication for negotiations with customers, other insurance carriers and attorneys to resolve claims.
• Reviewed, compiled and ensured accuracy of claim information for the Subrogation department to submit to other insurance companies and third parties in the subrogation process.
• Completed a CAT rotation to assist with high claims volume from customer impacted by Northern Hailstorm.
• Develops current expertise by completing continuing education training sessions.

Sugar Land, Texas

• Planed, prioritized, organized and completed work to meet established objectives.
• Reviewed, researched, and understand how a claim submitted by consumers and physicians/providers was processed and determine why it was denied.
• Identified and obtained all additional information, medical records, contract language, and (relevant process/procedures) needed to make an appropriate determination of the appeal on the claim.
• Coordinated all components of complaints/appeals including final communication to member/provider for final resolution and closure.
• Handled an average of 35 claims per day to address customer inquiries and concerns.
• Communicated appeal or grievance information to members or providers within the required timeframes and all appropriate internal or external parties (regulatory agencies, plan administrators, etc.)

• Determined payment or denial for each claim based on established rules and processes.
• Review and research assigned claims by navigating multiple computer systems and platforms and accurately capturing the data/information necessary for processing (e.g., verify pricing, prior authorizations, applicable.
• Ensure that the proper benefits are applied to each claim by using the appropriate processes and procedures (e.g., claims processing policies and procedures, grievance procedures, state mandates, CMS/Medicare.
• Completed daily all data entry required to document and communicate the status of claims as needed adhering to all reporting requirements.
• Learned and leverage new systems and training resources to help apply claims processes/procedures appropriately.