Erin Sultanovic
Cumming
Summary
Dynamic Claims Adjuster with extensive experience at Safeway Insurance Company, excelling in claims review and conflict resolution. Proven track record of effectively managing complex claims, training teams, and enhancing customer satisfaction. Adept at identifying fraudulent activities while maintaining compliance with industry standards and regulations.
Overview
13
13
years of professional experience
Work History
Claims Adjuster
Safeway Insurance Company
10.2021 - 06.2024
- Prepared summaries of damage, payments and policy coverage.
- Examined claims forms and other records to determine insurance coverage.
- Verified insurance claims, determining fair settlement amounts based on policy coverage and damage assessments.
- Evaluated insurance policies and analyzed damages to determine coverage.
- Conducted comprehensive interviews of witnesses and claimants to gather facts and information.
- Reviewed police reports, medical records, and property damage to evaluate liability and inform claims decisions.
- Reviewed and analyzed suspicious and potentially fraudulent insurance claims.
- Investigated claims involving potential and suspected fraudulent activities.
- Interviewed agents and claimants to correct errors or omissions and investigate questionable claims.
- Trained claims staff on effective handling and evaluation of injury claims, enhancing team competency and compliance.
Claim Associate
State Farm Insurance Inc
07.2011 - 07.2021
- Established positive and trusting relationships with injured clients, administering efficient customer service and processing claims quickly.
- Managed large volume of medical claims on a daily basis.
- Examined claims forms and other records to determine insurance coverage.
- Paid or denied medical claims based upon established claims processing criteria.
- Reviewed provider coding information to report services and verify correctness.
- Maintained knowledge of benefits claim processing, claims principles, medical terminology and procedures and HIPAA regulations.
- Collaborated with claims department and anti-fraud organizations to resolve claims efficiently.
- Followed up on potentially fraudulent claims initiated by claims representatives.
- Conducted property investigations to identify and classify damages for claims resolution.
- Consulted with outside parties to resolve discrepancies and create effective solutions.
- Provided primary customer support to internal and external customers in fast-paced environment.
- Maintained customer satisfaction by addressing needs and resolving concerns proactively.
Education
High School Diploma -
Chattahoochee High School
Alpharetta, GA05.2005
Skills
- Claims
- Claims review
- Transaction reconciliation
- Documentation management
- Data analysis
- Problem solving
- Customer service
- Teamwork
- Conflict resolution
- Training development
Timeline
Claims Adjuster
Safeway Insurance Company
10.2021 - 06.2024
Claim Associate
State Farm Insurance Inc
07.2011 - 07.2021
High School Diploma -
Chattahoochee High School