Claims Adjuster
Resume:
Chere' Edwards
Licensed Claims Adjuster
Denton, TX 76209
adtnck@r.postjobfree.com
Administrative Skills- 24+ years experience in Physician reimbursement Billing/Collections. Working knowledge of HIPAA, CMS guidelines, CPT/HCPCS codes, electronic claims. Strong organizational, oral and written communication skills. Ability to work in a team fostered environment, multi-tasked environment while being self-motivated. CCC One Auto Estimating, NexGen, Microsoft Excel • Computer skills • Organizational skills • Communication skills • Customer service Willing to relocate to: Deployment areas
Authorized to work in the US for any employer
Work Experience
Auto Field Adjuster
PILOT CATASTROPHE SERVICE-Fort Worth, TX
June 2024 to Present
• Deployment
• Inspect vehicles at customers residence, repair shops for Hail and Wind Damage while using scope sheet and, taking photos
• Write up Estimate via CCC ONE.
• Documentation completed in NexGen system.
• Using hail dent shield to gather needed repairs
Member Service Representative
SGS Consulting- Christus Health-Irving, TX
March 2024 to June 2024
• Collects and provides patient and payor information to facilitate account resolution.
• Maintains payor specific knowledge of insurance and self-pay billing and follow up guidelines and regulations for third-party payers. Maintains working knowledge of all functions within Revenue Cycle.
• Responsible for professional and effective written and verbal communication with both internal and external customers in order to resolve outstanding questions for account resolution.
• Facilitates member & provider understand of the plan coverage and benefits by thoroughly researching inquiries in an efficient and professional manner
• Required to assist in training/re-training new and current employees
• Responsible for handling all incoming calls and the making of outgoing calls as needed in order to resolve any issues or questions
• Provided excellent understanding of benefits, products, & other health care and/or insurance issues as they pertain to the member
Agent Advocate Inside Adjuster
Pilot Catastrophe Services-Fort Worth, TX
April 2023 to October 2023
Allstate- Insude Auto Adjuster
• Answering inbound calls; Outbound calls to customers by telephone, written correspondence and/or various electronic media
• Effectively managing work through task driven queues while multi-tasking in a fast-paced call center environment
• Supporting our customers through personalized, caring, and simple interactions
• Investigating, evaluating, negotiating, and settling claims
• Applying knowledge of policies, and insurance regulations when determining coverage, liability, & damages
Auto Express ECTA- StateFarm
TheBest Claims Solutions-Irving, TX
November 2022 to March 2023
• Contacting customers by telephone, written correspondence and/or various electronic media
• Effectively managing work through task driven queues while multi-tasking in a fast-paced call center environment
• Supporting our customers through personalized, caring, and simple interactions
• Investigating, evaluating, negotiating, and settling claims
• Applying knowledge of policies, and insurance regulations when determining coverage, liability, & damages
Total Loss Claims Adjuster- AllState
Pilot Catastrophe Services-Fort Worth, TX
October 2022 to October 2022
• Hurricane Ian Deployment- 2wk training, Total Loss Flood claims. Class A CDL Driver
R&L Carriers-Sanger, TX
September 2021 to September 2022
• Delivers and unload products using a pallet jack
• Informed customers of critical details and procedures for submitting claims for damages.
• Stayed in frequent communication with dispatch to quickly adapt to customer demands and route changes.
• Maneuvered vehicles with high degree of skill through narrow passageways and around obstructions such as parked cars.
• Handled load documentation, obtained signatures and provided copies to destination staff.
• Maintained current Class A CDL with Hazardous Materials and Doubles and Triples and Tanker endorsements.
Class a CDL Driver
Swift Transportation-Lancaster, TX
March 2020 to September 2021
• Delivered refrigerator items from Texas to Denver, CO, Raton, NM for daily deliveries to a local retail store.
• Completed on-time deliveries by choosing best and most efficient routes.
• Operated vehicle safely in highly congested areas with no traffic violations.
• Adhered to safe lifting techniques to avoid injuries. Medical Claims Specialist
Ascension Health-Richardson, TX
October 2017 to October 2020
• Timely follow-up on all accounts assigned, work accounts as established procedures until account is resolved, sent to legal, or disputed
• Daily calls to payers to obtain payment resolution and account status information
• Follows and maintains patient, account and client confidentiality at all times
• Adheres to HIPAA and Compliance Policy Guidelines. Medical Collections Specialist
Dynamic Global & Temp Agencies-Dallas, TX
January 2014 to October 2017
A/R follow up, Timely filing / Appeals
Check mail daily for payments, EOBs, etc
Payment posting, Maintained A/R report to keep balances under 120 days. Collected and documented patient medical information such as blood pressure and weight. Performed clerical duties, such as word processing, data entry, answering phones and filing. Medical Collections Specialist
Reimbursement Solutions Specialist- Formerly PRS Group-Bellaire, TX September 2008 to December 2013
Responsibly managed assigned accounts in an organized and efficient manner, electronic/manual submission of claims
Handle operational issues, including Patient financial service needs Posting Payments, Medical Billing Submission of
Appeals, Train new hire on current software, Assist manager in monthly reports, etc physician fees billed to, Medicare,
Managed Care
Commercial Driver's License (CDL)
Class A
State: TX
Endorsements: X (Tank + Hazardous) - T (Double/triple trailers) - N (Tank vehicles) Skills
• Analysis skills
• Medicare
Certifications and Licenses
Claims Adjuster(All lines)
April 2022 to June 2024
• Licensed Home State TX,-2834521
• AL,OK, KY, La, FL, GA, NM, MI, MT, WV
• State Farm Auto/Property Certified
Notary Public
March 2021 to March 2025
Notary Id# 13297787-6
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