Melanie Queen
Colorado Springs
Summary
Service-oriented Claims Adjuster skilled at applying creative approaches to solving complex problems. Adept at developing profitable and quality-focused processes.
Overview
14
14
years of professional experience
Work History
Sr. Complex adjuster
USAA
Colorado Springs
10.2024 - Current
- Investigated complex claims, leveraging analytical skills to assess damages and determine fair settlement outcomes.
- Collaborated with cross-functional teams to streamline claims processing, enhancing operational efficiency and client satisfaction.
- Developed and implemented strategic initiatives to reduce claims processing time, resulting in improved service delivery.
- Engaged with policyholders to clearly communicate claims processes, enhancing understanding and trust in the resolution process.
- Determined salvage value for total-loss vehicles.
- Documented vehicle damage and condition by taking meticulous notes and photographs.
- Managed heavy workload of ongoing cases thanks to strong organizational, time management, and collaboration skills.
- Evaluated extent of damage and documented findings.
- Analyzed police reports, medical records, witness statements, photographs, and other evidence to determine claim validity.
- Determined whether an accident was caused by driver negligence or mechanical failure.
Auto Non-Injury Core Adjuster
USAA
Colorado Springs
07.2023 - 10.2024
- Investigates and determines coverage and liability.
- Interact with all parties involved to gather information to determine liability.
- Investigated and assessed damage to property and reviewed property damage estimates.
- Communicate with all parties involved and assist with claims process.
- Contributed to team success by participating in regular training sessions, sharing best practices, and mentoring new adjusters.
- Voicemail champ. Pulling and returning all incoming voicemails in a timely fashion.
- Monitoring teammates desk.
Intake Representative
EVICORE HEALTHCARE
10.2018 - 03.2022
- Responding to in-coming calls
- Data entry
- Submitting Prior Authorizations for various Health plans
- Aided with website issues
- Determined patient eligibility by reviewing patient documentation for completeness and accuracy
- Added to case information with dates of service, diagnosis or procedure codes and facility and doctor information
- Updated patient information on computer system to maintain billing accuracy
- Scheduled appointments for consultations, tests and procedures by determining doctor availability.
Customer Service Representative
ALORICA
08.2012 - 12.2013
- Maintained clean work areas, grounds and landscaping to keep areas safe and appealing
- Dressed children and changed diapers
- Created developmentally appropriate lesson plans
- Organized and stored toys and materials to ensure order in activity areas
- Performed general administrative tasks, such as taking attendance, editing internal paperwork and making phone calls
- Read to children and taught them simple painting, drawing, handicrafts, and songs
- Sanitized toys and played equipment
- Observed and monitored children's play activities
- Responded to incoming calls
- Answered billing questions
- Provided basic technical support
- Addressed customers courteously using suitable methods and problem-solving skills
- Provided account information to customers and explained bill service policies and customer rights
- Remained open to feedback from supervisor and peers to build and improve skill set.
Education
GED -
Pikes Peak Community College
Colorado Springs, COSkills
- Damage Assessment
- Highly motivated
- Claims Investigation
- Policy Interpretation
- Insurance policy coverage knowledge
- Claims Processing
- CCC Reports
- Problem-solving abilities
References
References available upon request
Timeline
Sr. Complex adjuster
USAA
10.2024 - Current
Auto Non-Injury Core Adjuster
USAA
07.2023 - 10.2024
Intake Representative
EVICORE HEALTHCARE
10.2018 - 03.2022
Customer Service Representative
ALORICA
08.2012 - 12.2013
GED -
Pikes Peak Community College