Tenesha Wafer

Familiar with handling VPD, Cargo, and Car Hauler claims.

Promptly and properly develop the claim file to provide accurate and timely investigations and loss analysis.

Responsible for communicating with repair facilities, tow yards, appraisers and all participating parties when handling vpd, cargo and car hauler claims.

Maintain an active to diary to achieve timely development of file.

Adhere to all statutory regulations and unfair claim practice,

• Reviewed insurance policies to assess coverage levels, facilitating claims approval or denial decisions.
• Investigated automobile damage and assessed property damage estimates.
• Analyzed police reports, photos, and physical damage to ascertain liability extent.
• Conducted recorded statements with insured individuals, claimants, and witnesses to gather crucial information for claims handling, while also identifying suspicious losses for investigation by the SIU.
• Maintained compliance with state regulatory requirements through meticulous documentation and adherence to company policies.

• Performed quality audits for patient registration and customer service, including call monitoring assessments.
• Utilized Trace and VO/Video Observer to score calls and troubleshoot CRM issues via Tableau.
• Conducted monthly one-on-one meetings with agents to offer feedback and coaching on call performance.
• Collaborated with call center management to review quality assessment outcomes, recommending improvement activities as needed, and adapted teaching methods during one-on-one sessions based on agents' learning styles. Identified non-compliance issues and escalated reports to senior personnel.
• Educated and oriented employees to improve compliance with quality control protocols.

• Conducted insurance verification for inpatient and outpatient procedures and scheduled appointments as required.
• Prioritized confidentiality of patient data in compliance with HIPAA regulations, ensuring privacy and security of health information.
• Provided personalized patient care, serving as the primary liaison between patients, doctors, and hospital staff.
• Reviewed medical charts thoroughly and maintained effective communication to ensure seamless coordination among hospital departments. Educated patients on preparation instructions for upcoming procedures and tests.
• Ensured accurate patient information collection by implementing a thorough data verification system.

• Coordinated and managed daily operations, including scheduling, communication, and travel logistics, streamlining workflow for efficient claims processing.
• Monitored and controlled administrative budgets, optimizing resources to support effective claims management.
• Supervised employee timekeeping, ensuring precise recording and submission of hours for timely and accurate payroll processing in alignment with claims department needs.
• Reviewed and analyzed contracts to resolve billing discrepancies with vendors and verified claim data corrections in preparation for processing.
• Processed claims in adherence to established quality and assurance standards, proactively making corrections and adjustments to address any issues before order processing.