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Professional Health Insurance & Claims Adjuster

My ideal job in Health insurance is to achieve solid sales growth, and acquire new clients while maintaining current clients. As a claims adjuster I'm seeking opportunity to utilize my current experience with a company that is growing to provide me the opportunity to advance my skills.

Claims Adjuster

Longwood, FL

About Me

Industry:	Insurance
Occupation:	Claims Adjuster
Ideal Companies:	I would like to work with any company that I can utilize my professional skills whether it's health insurance or claims adjuster that will offer stability and growth.

Education level:	Specialist
Will Relocate:	Yes
Location:	Longwood, FL

Work Experiences

9/2007 - 9/2008

Wellcare

Individual Contributor

Benefit Consultant for Medicare Advantage insurance for AEP & OEP. Generated referrals utilizing sources other than support by corporate. Prospects for leads converted into appointments. Utilized territorial model philosophy to maximize marketing efforts in attaining new enrollments. Maintains retention rate that deemed acceptable from the company. Enrolled an facilitated events. Achieved corporate enrollment goals using approved presentation material in home and seminar settings. Public speaking/relations. Audits enrollment paperwork for accuracy. Created flyers, pamphlets, and travel to other territories. Conducted new member orientations.

9/2006 - Present

(private)

Contractor / Freelance

Recurring position in call center environment enrolling employees in group benefits during their open enrollment period for employees' Core Benefits, LTD, STD, AD&D, Whole and Term Life, and Critical Illness Plans.

5/2006 - 9/2007

Connextions

Contractor / Freelance

Top producing agent call center environment selling BCBSFL individual and medicare policies. Pre-qualified potential members, provided NEADS analysts, explain plans in details, completed application online, explain HIPPA acknowledgments, respond to MUD correspondence, and provided applicant with MUD final disposition.

2/2006 - 6/2006

United Health Care Group

Contractor / Freelance

Customer Service Representative Provided superior customer service during merger of Pacificare and Secure Horizon with UHC. Explain new procedures and polices to Medicare members. Process payments, answer billing questions, and filed grievances, and other customer service duties.

4/2005 - Present

(private)

Contractor / Freelance

Health Staff Solutions Conyers, GA 02/05-Current Field adjuster road warrior processing claims for worker compensation handling lost time, special disability, and subrogation. Knowledge of IC-9, Interqual Criteria, worker compensation statues and division of workers compensation rules for GA and FL. For P/C claims investigate, access damage, and determine cause, and complete cases in timely manner. CAT certified for 2009 storm season with Citizen.

1/2005 - 6/2006

Nations Health

Contractor / Freelance

Contracted with Cigna to enrolled medicare members into Medicare Part D (prescription drug plan). Enter codes into Argus to ensure member received the correct co-pay for their medication(s). Filed grievances/appeals for members with disputes.

6/2001 - 11/2004

Atlantic Mortgage

Manager

Negotiate loan terms and conditions on behalf of the lender. Gather, produce, and prepare closing documents for underwriter. Notified borrower on mortgage insurance, survey, and encroachment information.Prepared federal, state mandate statements, and mortgage company disclosures. Communicated with borrower to assure lenders contingencies were completed. Attended closing with borrower to ensure compliance.Consultant for nonprofit developer for low to moderate income housing development. Developed and implemented training strategy and state compliance laws. Participated in long-range planning and development of marketing. Solicited proposals from private development companies and analyze projects.Coordinated with various business, agencies, community, organizations, and city/county departments to conduct presentations and site tour for the purpose projects. Researched and complied demographic and economic data in response to prospective client inquires. Conducted first time buyers class to qualified applicants.

5/1986 - 6/2001

Ford Motor Co

Individual Contributor

Created sales strategies for marketing Lincoln Mercury brand with Olgivy and Mathers. Follow through on details to ensure success. Attend gala and events sponsor by Ford Motor Co. Maintain client relationship while established new client. Provide monthly reports to senior manangement on print/media advertisement budget. Ensure progress and goal achievements to reach yearly forcast.