Ruby Scott Email & Phone Number

Clearwater, Fl

Worked on a temporary assignment as a claims adjuster for various customer accounts, issuing credits and adjustments. Additional duties were Investigating purchase orders, determining and tracking original purchase orders, comparing original orders, determining if promo discounts, taxes and unit orders were applied correctly to orders processed, Issuing credits, adjustments and discounts to customer orders and tracking errors to the appropriate departments and individuals. Follow-up with customers on status of adjustments on their accounts Utilized the oracle database to manipulate and review claim adjustments.

Clearwater, F;

Currently working part time as a verification customer service representative for Medical Alert buttons sold for and to seniors early response system. Verified and processed orders, such as credit card, check authorizations, delivery instructions, etc. Reviewed all customer service orders and complaints to final resolutions. Tracked customer service orders, and corrected errors for billing, adjustments and credit discrepancies

Clearwater, Fl

Worked as a verification supervisor, current duties are as follows: Confirm magazine orders on new and existing customer accounts. Confirm all customer information entered in the computer system entered by the sales representative, such as name, address, phone numbers, prior magazine information and identification numbers. Discuss the various subscription rates and updates. Review and discuss billing information with customers and confirm payment options such as credit card and checking account information. Review and discuss credit card denials with customers and request for additional payment options to complete order processing. Discuss and review customer service concerns as it relates to placing magazine orders, company credibility, and sweepstakes drawings, Provide outstanding customer service while responding and answering the customer’s questions and concerns to account resolution

Irving, Tx

Minnesota, Kansas, Missouri, Nebraska, Indiana, Michigan, Ohio, Arkansas, Kentucky, Louisiana, Mississippi, Tennessee, Oklahoma, Texas, Pennsylvania, Alabama, Georgia, North Carolina, South Carolina, Adjusted claims for total loss exposure relating to hail, windstorm, flood and tornado damage. Processed rapid settlement losses, documented coverage, subrogated prior losses per policy guidelines. Ram DMV checks per specific state regulations and policies. Interpreted state local issues and policies relating to the specific guidelines and processed payments. Reviewed specific state thresholds and determined the actual cash value per each states local issues. Entered ACV agreed date in ARMS. Determined who holds the title when a lien holder exists. Reviewed odometer statements to determine authenticity. Reviewed policies to determine if a power of attorney was required for car titles or titles with liens. Determined the tax rates for state, county and city. Reviewed guidelines for owner retained vehicles including leased vehicles and obtained the appropriate salvage bids per each state. Determined if titles had to be branded, issued appropriate letters through Next Gen claim software. Reviewed clams for prior loss’s. Reviewed policies for rental coverage and determined the rental time frame for the insured. Reviewed state guidelines for personal effects coverage under the insured policy and paid additional benefits for clothing, luggage or other contents lost in the insured vehicle or trailer. Obtained salvage bids (pro quotes) from various salvage yards. Oklahoma claims requested tribal title and tag fees, and copy of tribal card. Provided appraisals and estimates for vehicles damaged as a result of Hurricane Irene in New York City outstanding customer service and attention to detail was required for this position.

Worked as a loan processor for a major bank. Reviewed the following types of loans Conventional, FHA,VA, Rural Housing and foreclosed home loans and land purchases for accuracy to be entered in the Ruby system. Processed refinanced and new purchased home loans and land purchases within all 50 states. Analyzed financial documents such as pay vouchers, prior loans, taxes information, credit scores, charge accounts, and prior bank loans. Reviewed appraisals to confirm all information was properly completed. Referred loan documents to other departments for further review.

Worked as a PIP Adjuster at an Insurance company in the Tampa bay area. Job duties involved: Reviewed new losses, explained coverage to insured, attorney and claimants. Discuss and established coverage and open appropriate reserves as it relate to the specific loss. Refer claim to claim assistant to request police reports, run accurint, and ISO data base to clear coverage. Responded timely to attorney disclosures. Investigate claim information to rule out claimants own PIP source, Material Misrep, unlisted household members and garaging issues. Review PIP applications, wage loss, disability slips, and house hold services receipts receive from insured and claimants. Utilized Reflections and eMedical software applications to send letters, update claimant information, set reserves, set pay authorizations with direction for processor to pay claims. Input claim information, sent PIP Applications, med authorizations, wage loss, mileage reimbursement and other correspondence to insured or claimants. Obtained insurd’s or claimant’s statements as it relates to the facts of loss. Confirmed injuries and treatment, employment, wage loss, accident details from all claimants to determine liability. Established reserves for lien hospital and ancillary bills. Determined Medicare eligibility, and reviewed claim file for Medicare set asides. Provide Medicare information to claimants and insurds as it relates to claim payments. Referred claims to payment processor to pay bills in accordance to the Fee Schedule and process Med Pay payments. Advise insurds and claimants on Med Pay subrogation. Sent Med Pay subrogation letters to At Fault Carrier. Additional adjuster duties as it relates to the entire claims process.

Worked part time in a call center where I provide the following service: Confirmed retail orders placed and purchased from the television and internet, confirmed address, credit card and the delivery of the specific items purchased by the customers. Provided customer service for returns, complaints and credit card charges. Introduced new products, introductory offers and specials to the customers also known as up sales.

President, owner and operator of the claims consulting company which included the following:Marketing, Sales and Services to healthcare providers who would like to improve their ROI (Return On Investment) as it relates to their RCM (Revenue Cycle Management). Reviewed provider's contracts, negotiated with the insurance company's provider contracting representative, to insure the health care providers were paid in accordance with the signed contract. Requested amendments, revisions, restrictions or new policy and procedure guidelines from the insurance company. Reviewed insurance online training information, contracts and agreements. Analyzed EOB denials with providers, resubmitted denials to insurance carrier for review and payment. Reviewed provider's licensure and credentials for compliance and provided support on the credentialing process.

Job duties and functions included the following description:Reviewed new losses for coverage: MM, Pro-Rata, Fraud, Unlisted H/H members, Reviewed examination under oath (EUO) (no R/S) with UAIG -non standard Ins Co. Reviewed EUO statements, PIP Applications, Med Records, and various other data base searches to clear and confirm coverage. Established any Reservation of Rights (ROR) based on above and responded to all disclosures timely. Reviewed files for SIU and NICB. Worked with SIU representatives to monitor: clinics, providers, workers comp claimants, Medicare billing and insurds. Reviewed and updated ISO database with current injury information. Reviewed files for Mitchell Medical processor and providers billing errors. Negotiated and settled all pre-suit DEMANDS for compliance, and medical necessity, Prepared for Depositions (Depo) and responded to defense "ROGS" and "Affidavits" in a timely fashion. Attended mediations as it relates to the final resolution with the claim process.

PIP/BI/PD-ALL LINES ADJUSTERResponsible for reviewing new losses for Florida claims, and worked in the multistate claims unit. Conducted initial reviews which included recorded statements, adjusting reserves per exposure, sent PIP applications, ordered police reports, requested supporting documentation to confirm injuries. Determine slip and falls, and workers comp related injuries. Review disability slips, calculated wage loss, Referred to SIU department for NICB monitoring due to suspicious claims activity, or multiple claims history. Conducted criminal background checks, Review provider's tax identification and medical license numbers to determine provider's license activity. Negotiated IME/PEER reviews for to (RRN) reasonable, related and necessary treatment per diagnosis provided by treating physician. Issued PIP/MP + interest payments in accordance with the FL PIP statutes. Maintained a twenty one (21) day diary to avoid interest payments.Reviewed 15 day DEMANDS for payment. The 2008 Fl new statutes currently allow 30 days for DEMAND Responses which allow adjusters additional time for investigations, to clear coverage.PD/BI RESPONSIBILITIESDetermined liability using police reports, recorded statements, witnesses, EUO's and any other tools available to clear coverage. Open all applicable reserves or exposures relative to the claim, such as: PIP, Subrogation, and Total Loss PD and UM exposures. Determined liability and comp/negligent issues surrounding the claim. Scheduled vehicles for estimates and photos at preferred shops. Reviewed and authorized estimates and supplements. Set-up Rentals with Enterprise per estimate-ARMS software. Negotiated early BI settlements-cash outs with insured's for OOP expenses for soft tissue injuries, minor exposures and negotiated provider billing.

Scheduled appraisals to be reviewed and provided estimates for damaged vehicles. responsibilities included but were not limited to data entry into the Lynk system. The Lynk system was accessed by all Adjusters, Material Damage Appraisers, Salvage departments, Subrogation department and finally the Total Loss department. The data consisted of an assessment of the current claim estimates. Processed first party claim checks, obtained Total Loss reports from ADP. Analyzed and reviewed all vendor invoices for vehicle appraisals.Provide monthly independent appraisal report.

Processed and analyzed all medical claims via EDI and the Eriso /Claims software, and Claims Fax. Verified policy holder’s eligibility, policy period, and provider eligibility. Reviewed all medical records and supporting documentation to determine pre-existing conditions, if pre-conditions were identified, requested a continuation of benefits form from policy holders (COBRA). Reviewed all CAT claims, and adjusted reserves accordingly, and prepared file for audit, high dollar amount claims were approved by home office. Determined medical necessity on all claims, normal and catastrophic cases. Processed claims in and out of network, applied appropriate fees when necessary. Determined additional plans; COB, Workers Comp, Auto related Claims, slip and falls, processed bills, subrogated bills against appropriate payer.

Insurance Class

Activities and Societies: National Notary Association President of National Association of Professional WomenWorking to achieve Claims.

Business Administration

Education record

Business Administration