4340 Garrett Street
Three Rivers, MI 49093
Objective Searching for challenging position in which to utilize my Claims Investigator skills to their fullest.
- Remarkable experience in analyzing claims with regard to negligence, proximate cause and comparative negligence
- Sound knowledge of insurance law and accepted industry practices
- In-depth knowledge of varied types of insurance fraud and the strategies and methods
- Exceptional ability to read, analyze and understand common scientific and technical journals, financial reports and legal documents
- Ability to work effectively in a high-stress environment while maintaining a professional demeanor
Claims Investigator, August 2005 – Present
Globaloptions Group, Three Rivers, MI
- Utilized the historical approvals with same and similar payers.
- Utilized the FDA approval letters, compared Medicare policy guidelines with the patients indications.
- Pursued the legal action against payer.
- Implemented any other appropriate means to gain a favorable outcome.
- Tracked all cases in appeal for performance measurement and outcomes.
Claims Investigator, May 2000 – July 2005
JBS, Three Rivers, MI
- Confirmed the coverage, negotiated the settlement and identified subrogation.
- Obtained the detailed recorded statements with proven knowledge of investigative and interview techniques.
- Assured compliance to all applicable state regulations.
- Developed files for transfer and subrogation referral.
- Established the reserves and claims payable within the delegated authority.
Bachelor’s Degree in Accounts, Indiana University, Bloomington, IN