LaSabre Worthey
Union City
Summary
Dynamic Property Claims Adjuster with a proven track record at IDP Risk Control Services, excelling in medical and property claims processing and negotiation. Recognized for enhancing customer satisfaction through effective communication and achieving timely resolutions. Skilled in damage assessment and risk management, consistently delivering fair settlements while maintaining compliance with insurance regulations.
Overview
11
11
years of professional experience
Work History
Property Claims Adjuster
IDP RISK CONTROL SERVICES
08.2016 - Current
- Evaluated property claims to determine validity and compliance with policy terms.
- Conducted thorough inspections of damaged properties to assess loss and recommend settlements.
- Collaborated with clients, contractors, and legal teams to facilitate effective claim resolutions.
- Analyzed documentation and evidence for accuracy to ensure fair compensation decisions.
- Implemented risk management strategies to minimize future property claims exposure for clients.
- Developed comprehensive reports outlining claim findings, recommendations, and resolution strategies for stakeholders.
- Enhanced customer satisfaction with prompt communication and consistent follow-up on claim status updates.
- Achieved timely resolution of property claims by investigating, evaluating, and settling a variety of cases.
- Reduced company expenses by accurately determining coverage and negotiating cost-effective settlements with policyholders.
- Collaborated with contractors to verify repair estimates, ensuring fair settlements for both policyholders and the company.
- Facilitated smooth transitions during catastrophes as part of a disaster response team, quickly addressing large volumes of claims while maintaining high-quality service standards.
- Expedited claim resolutions by working closely with legal teams when necessary to resolve disputed cases or potential litigation issues.
- Interacted with witnesses and claimants.
- Negotiated favorable settlement terms for complex property loss situations involving multiple parties or competing interests.
- Scoped and photographed properties for defects and damage.
- Increased accuracy in damage assessments by utilizing advanced technology tools during inspections.
- Carefully reviewed claim information to verify accuracy and avert fraudulent claims.
- Identified suspicious losses and contacted the manager for investigative assistance.
- Reviewed police reports, medical treatment records, and physical property damage to determine the extent of liability.
- Visited customer locations to evaluate damage and provided cost estimates for remediation.
- Assisted homeowners by coordinating vendor services, emergency repair, cleaning and contractors.
- Continuously improved industry knowledge through ongoing professional development opportunities, staying current on trends and changes within the insurance field.
Accounts Receivable Consultant
LDW CONSULTANTS
01.2016 - Current
- Analyzed accounts receivable data to identify trends and discrepancies, enhancing accuracy in reporting.
- Managed collections processes, ensuring timely payments and adherence to company policies.
- Developed comprehensive reconciliation procedures, improving the efficiency of month-end closing activities.
- Conducted regular audits of accounts receivable records, ensuring compliance with internal controls and regulations.
- Enhanced cash flow by diligently tracking and reconciling customer payments, ensuring prompt resolution of discrepancies.
- Deposited checks and worked with the accounting supervisor to determine coding and prepare related entries.
- Collaborated with cross-functional teams to resolve billing disputes, fostering positive client relationships.
- Managed vendor relationships, negotiating contracts for cost-effective services.
- Streamlined office operations to enhance communication and workflow efficiency.
- Managed subrogation claims process, ensuring compliance with legal and regulatory requirements.
- Analyzed claim documentation to identify liability and recoverable amounts effectively.
- Reviewed and processed medical claims to ensure compliance with policy guidelines and regulations.
- Evaluated claim documentation for accuracy, completeness, and adherence to established protocols.
- Supervised medical claims processing to ensure compliance with regulatory standards and internal policies.
- Collaborated with cross-functional teams to streamline claims review processes and enhance operational efficiency.
Denial Specialist
Parallon Workforce Solutions
05.2014 - 01.2016
- Analyzed denial reports to identify trends and root causes, implementing corrective actions to improve claims processing.
- Collaborated with cross-functional teams to resolve complex denial issues, enhancing communication and workflow efficiency.
- Developed and maintained documentation for denial management processes, ensuring compliance with regulatory standards.
- Trained junior staff on best practices in denial resolution, fostering skill development and knowledge sharing within the team.
- Conducted audits of denied claims, ensuring accuracy and consistency in appeal submissions to maximize recovery rates.
- Streamlined denial tracking systems using advanced analytics tools, improving response times for appeals by 30%.
- Mentored new hires on denial management strategies, cultivating a knowledgeable workforce equipped to handle complex cases effectively.
- Maintained knowledge of insurance coverage benefit levels, eligibility systems and verification processes.
- Improved claim denial resolution by thoroughly researching and identifying root causes of denials.
- Identified root cause of denials to provide plans for denial resolution.
- Documented medical claim actions by completing forms, reports, logs and records.
- Reduced aging accounts receivable balance with timely appeal submissions for denied claims.
- Examined medical treatment records and medical bills to gauge overall extent of liability.
- Collaborated with billing department staff to ensure accurate coding and charge entry, minimizing future claim denials.
- Conducted regular audits of denied claims, identifying areas for improvement in the revenue cycle process.
Education
Bachelor of Arts - Accounting And Finance
Faulkner University
Montgomery, AL05-2006
Skills
- Claims processing
- Claims investigation
- Excellent people skills
- Damage assessment
- Excellent time management skills
- Estimating repair costs
- Personal accountability
- Property inspection
- Insurance regulations
- Insurance policy knowledge
- Decision-making
- Microsoft Office Suite
- Policy investigations
- Fraudulent claims investigation
- Risk management
- Claims adjustment
- Negotiation and mediation
- Healthcare common procedures coding system (HCPCS)
- Accredited claims adjuster
- Certified claims professional
- Client interviewing
- Teamwork and collaboration
- Database management
- Time management
- Attention to detail
- Problem-solving abilities
- Multitasking Abilities
- Reliability
- Excellent communication
- Computer skills
- Customer service and support
- Organizational skills
- Team leadership
- Claims
- Goal setting
Timeline
Property Claims Adjuster
IDP RISK CONTROL SERVICES
08.2016 - Current
Accounts Receivable Consultant
LDW CONSULTANTS
01.2016 - Current
Denial Specialist
Parallon Workforce Solutions
05.2014 - 01.2016
Bachelor of Arts - Accounting And Finance
Faulkner University