New York Claims DivisionAnalyze claim information to determine coverage and fault.Investigate claims through witness interviews and document review.Manage vehicle repair processes in collaboration with appraisers.Negotiate effectively with customers and other insurance carriers to achieve fair claim settlements.

Followed written risk and compliance policies, standards, and procedures for business activities. Applied proficient knowledge of personal lines insurance to assist members with moderately complex quotes, binding new business, various ratings, policy protocols, billing and payment, underwriting, contract and coverage provisions, and premium changes for products and services. Responsible for the respective trailing documents for all states requirements and offerings. Identified and managed existing risks that stem from business activities and the job role. Ensured risks associated with business activities are effectively identified and monitored.Facilitated the Prop & Casualty experience by managing insurance inquiries from USAA members. Created content for staff development and documentation to support best practices. Effectively operate in a fast-paced environment and navigate multiple systems/programs while maintaining an emerging member interaction that occurs across multiple channels.  Led the team and Insurance Department as top sales performer for 4 months. Received a promotion within a year for consistent performance in exceeded expectations. Appointed P.O.C. (point of contact) for sales and service update training for the team.

Managed all call flow for the Department of Economic Opportunity, assisted agents with all aspects of claimant data and case information to ensure claims are processed accurately. Managed escalated and any pending issues to the adjudication department for further investigation or to remove pending issues holding benefit payments. Oversaw a team of 29 agents and collaborated with management to delegate the daily workload.Reset PIN logins and assisted with accessing files within the DEO website for users/claimants in need of IT assistance, technical support with website and claimants’ sensitive data information.Monitored calls for agents in need of additional training and performance improvement.

Managed the development and execution of all training programs, communicated with various department managers and content experts to determine training needs for organization and Franchisees, researched and identified areas in which training was required. Designed, drafted and acquired all training materials, handbooks, and manuals for trainees. Coordinated all travel plans, hotels arrangements and accommodation for all Franchisees. Led and operated training segments with PowerPoint presentations or via webinar. Organized and hosted all training events, on and off site for Franchisees and their staff.

Verified coverage and benefits for all commercial and private insurance, Workers Compensation and No-Fault insurance (PIP & Medical Payments). Obtain authorization for services and rehabilitation for physical therapy. Obtain prior authorizations, communicate, and negotiate authorization with claim adjusters. Assured all information obtained is accurate for claim processing. Managed incoming calls, update patient insurance information, appeal denials of authorizations.

Interviewed patients to determine appropriate orthotics or products for their condition. Communicated with medical providers about patients’ medical conditions for our products. Educated patients on the features and benefits of medical products. Data entry, distributed incoming/outgoing mail, fax, answer all calls. Follow up calls to patients for future medical supplies/products. Managed all retention orders to successfully retained customers.

Billing and enrollment specialist for HumanaOne individual health insurance.Process plan changes, terminations, reinstatements and managed billing issues.Led a team of 12 specialists in the retention department to oversee any potential policy cancellations and managed staff daily workloads by delegating projects.De-escalate supervisor calls and unresolved accounts issues.Awarded for effectively communicating & impeccable customer service to members.