Janine Hall
Claims Adjuster
Philadelphia,PA
Summary
Results-driven Claims Examiner with extensive experience at Sedgwick CMS, adept at claims processing and data verification. Proven track record in enhancing efficiency through process improvements and mentoring junior staff. Strong investigative skills complemented by exceptional verbal communication, achieving favorable settlements while ensuring compliance and customer satisfaction.
Overview
19
19
years of professional experience
Work History
Claims Examiner
Sedgwick CMS
Marlton, NJ
02.2022 - Current
- Analyzed claims data to determine eligibility and compliance with policies
- Coordinated communication between claimants, adjusters, and medical providers
- Reviewed documentation for accuracy, ensuring timely processing of claims
- Implemented process improvements to enhance efficiency and reduce turnaround times
- Trained new team members on claims examination procedures and software systems
- Resolved complex claims issues by conducting thorough investigations and evaluations
- Mentored junior examiners in effective claims handling techniques and compliance standards
- Handled sensitive information with discretion, ensuring confidentiality of personal and financial details for claimants throughout the claims examination process.
- Enhanced customer satisfaction by promptly addressing inquiries and providing accurate information on claim status.
- Negotiated settlements with claimants'' attorneys when needed, achieving favorable outcomes for both parties while minimizing costs.
- Conducted thorough investigations of complex claims, gathering relevant documentation and interviewing witnesses when necessary.
Litigation Adjuster
GEICO
Marlton, NJ
11.2010 - 07.2020
- Evaluated liability and damages for complex claims, ensuring compliance with state regulations.
- Negotiated settlements with claimants and legal representatives to achieve favorable outcomes.
- Collaborated with legal teams to prepare cases for litigation, enhancing case strategy development.
- Conducted thorough investigations into claims, gathering evidence to support decision-making processes.
Claims Adjuster
AllState
Malvern, PA
06.2007 - 07.2010
- Analyzed subrogation claims to identify recovery opportunities and mitigate financial losses.
- Coordinated with external vendors to gather necessary information, ensuring comprehensive investigation of claims.
- Streamlined claim review process, enhancing efficiency in case assessments and resolution timelines.
- Utilized analytics tools to evaluate claim data patterns for better identification of potential subrogation targets.
Education
Master of Science - Business Administration And Management
Capella University
Philadelphia, PA08-2016
Bachelor of Science - Education
Temple University
Philadelphia, PA 05.2001 -
Skills
Claims processing
Verbal communication
Data verification
Disability claims process
Claims evaluation
Decision-making
Investigative skills
Customer service and support
Critical thinking
Timeline
Claims Examiner
Sedgwick CMS
02.2022 - Current
Litigation Adjuster
GEICO
11.2010 - 07.2020
Claims Adjuster
AllState
06.2007 - 07.2010
Bachelor of Science - Education
Temple University
05.2001 -
Master of Science - Business Administration And Management
Capella University