Kimberley Jones Email and Phone Number

- Serves as the main point of contact for assigned Physicians. - Primary areas of focus include inbound and outbound appointment scheduling, triage of patient questions, insurance verification and authorization, surgery scheduling, and daily problem solving to ensure patients expectations and needs are met.

- Manage a team of 7 Examiners for the Disability Claims Department- Monitor collegue's workloads and provide training-Provide support, guidance, leadership and motivation to promote maximum performance - Communicate to the Client on a weekly claims review call on current claim trends

• Manage and investigate a caseload of 150 moderate to high complexity claims (IN, IL, KS, MO)• Establish and maintain accurate and timely reserves on the files• Direct the medical treatment of the claimants with the guidance of the nurse case managers• Calculate and issue TTD, TPD, PPI ratings to the claimants• Analyze information obtained through investigation in order to evaluate claim and determine extent of injury and compensability. Analyze and consider contributory or comparative negligence for purposes of subrogation • Evaluate, negotiate and settle litigated and non litigated claims within delegated authority • Review and approve provider bills that are directly related to the covered injury • Document claim files and maintain control of work through documentation or diary system • Offered superior customer service

• Responsible for timely claims adjudication and claims investigation of foreign and domestic medical claims within the policy guidelines• Worked with medical providers on obtaining needed medical records for review for a claims determination• Documented claim files and maintained control of work through documentation or diary system. Onboarding trainer for new hires

• Managed a caseload of 175 medical only claims (IN, IL, MI, IA, NJ)• Established and maintained accurate and timely reserves on the files• Investigated claims thoroughly, including coverage, liability and exposure • Handled correspondence from insured’s, claimants, providers and agents regarding questions or problems associated with claims• Analyzed information obtained through investigation in order to evaluate claim and determine extent of injury and compensability. Analyzed and considered contributory or comparative negligence for purposes of subrogation • Evaluated, negotiated and settled non-litigated claims within delegated authority • Reviewed and approved provider bills directly related to the covered injury • Document claim files and maintain control of work through documentation or diary system . Trained New Hires in the Claims Department

• Liaison between the Claimant and Claims Adjuster• Processed payments on the auto claims• Set task for inspection of vehicles involved in the auto claim• Scheduled and took statements of all parties involved in the auto claim• Created all the form letters on the claims.• Ordered police reports• Copied claim files to send to attorneys (CD and paper form)

• Responsible for timely claim adjudication and investigation of foreign and domestic medical claims within the policy parameters• Reviewed medical records as part of the claim investigation• Set up and completed follow ups on claims in a timely manner• Offered superior customer service .Trained the new hires on systems and claims adjudication per policy standards