Krystine Hepp
Locust Grove,VA
Summary
Dedicated and detailed oriented professional with over 20 years of customer service experience and 8 years of claims handling experience. Great listening, verbal and written communication skills. Examiner with outstanding critical thinking and investigative abilities. Proven ability to handle multiple tasks effectively and efficiently in fast paced environment Proactive and goal-oriented professional with excellent time management and problem-solving skills. Known for reliability and adaptability, with swift capacity to learn and apply new skills. Committed to leveraging these qualities to drive team success and contribute to organizational growth. Seeking a position that challenges and provides the opportunity to reach my full potential professionally and personally utilizing my abilities and years of experience.
Overview
21
21
years of professional experience
Work History
Personal Injury Examiner (PIP Adjuster)
GEICO
04.2023 - Current
- Delaware residence licensed Adjuster
- Handled Med Pay/PIP for multiple states: DE, MD, DC, PA, VA, NY, FL, NC and various other states
- Maintained inbound/outbound communications from direct line
- Investigate medical primacy laws
- Determine if Independent Medical Examination (IME) is needed for each injured party. Refer for exam and follow process to resolution
- Draft disclaimers and denials after conducting coverage investigation
- Participated in ongoing professional development opportunities to stay current on industry changes and maintain
- Investigate for subjugation potential
- Analyzed policy details along with supporting documents provided by healthcare providers to make informed decisions on claims approvals or denials.
- Resolved complex claims issues for expedited processing and resolution.
- Collaborated with healthcare providers to obtain necessary documentation for claim support.
- Provided exceptional customer service to both internal and external associated parties during the entire claim lifecycle process.
- Conducted thorough investigations of medical claims to ensure proper payment or denial.
- Improved customer satisfaction with timely and accurate claim settlements.
- Maintained strict compliance with HIPAA regulations, safeguarding patient privacy throughout the claim evaluation process.
- Identified patterns of fraudulent activities through meticulous analysis of medical claims data.
- Managed high volume caseloads, a pending of 100 plus files
- Negotiated fair settlements with healthcare providers, ensuring cost-effective resolutions for injured parties
- Managed large volume of medical claims on daily basis.
- Reviewed provider coding information to report services and verify correctness.
- Maintained knowledge of benefits claim processing, claims principles, medical terminology, and procedures and HIPAA regulations.
- Researched and resolved complex medical claims issues to support timely processing.
- Monitored and updated claims status in claims processing system.
- Paid or denied medical claims based upon established claims processing criteria.
- Evaluated medical claims for accuracy and completeness and researched missing data.
- Used administrative guidelines as resource or to answer questions when processing medical claims.
- Responded to correspondence from insurance companies.
- Delivered exceptional customer service to policyholders by communicating important information and patiently listening to issues.
- Read over insurance policies to ascertain levels of coverage and determine whether claims would receive approvals or denials.
- Researched claims and incident information to deliver solutions and resolve problems.
- Reviewed police reports, medical treatment records, and physical property damage to determine extent of liability.
- Maintained contact with claimants and attorneys to determine treatment status.
Independent Medical Exam Coordinator (IME)
GEICO
03.2019 - 09.2023
- Identified and investigated need for medical examinations by third party vendor
- Drafted 100s referrals monthly to be reviewed by third party vendor
- Processed medical records to separate SharePoint site
- Drafted state compliance letters for each referral
- Communicated with injured parties/attorneys regarding appointment details
- Handled rescheduling and canceling of appointments
- Communicated both verbal and written results of examination
- Drafted reservation of rights and disclaimers
- Trained other sections/regions on the IME process
- Handled vendor invoices
- Handled all IMEs for the DE/MD/DC for entire company
- Assisted on Pennsylvania Peer Reviews
Telephone Claims Representative (TCR 1)
GEICO
06.2017 - 03.2019
- DE resident licensed adjuster
- Maintained accurate records of all claims and consistently updated the database with relevant information, ensuring easy access for future reference.
- Upheld strict confidentiality standards when discussing sensitive information related to policyholder''s personal details or claim specifics.
- Increased efficiency within the team by cross-training in multiple areas of expertise, allowing for seamless coverage during peak periods or staff absences.
- Enhanced customer satisfaction by promptly and accurately addressing insurance claims over the phone.
- Provided mentorship to new hires, sharing knowledge and experience in order to expedite their learning curve within the role.
- Coordinated effectively with other departments as needed when handling interrelated claims or escalating issues requiring further attention outside of my scope as a Telephone Claims Representative.
- Built strong relationships with policyholders, fostering trust and loyalty through consistent professionalism in all interactions.
- Reduced company costs by identifying fraudulent claims through thorough investigation and accurate assessments.
- Expedited claim processing times by efficiently gathering and organizing necessary documentation from callers.
- Managed a high volume of incoming calls *50 plus* daily, prioritizing tasks efficiently to ensure timely resolution of all cases.
- Adapted quickly to changing company policies, procedures, or technology updates—ensuring seamless service delivery at all times.
- Streamlined department workflow by collaborating closely with team members, sharing best practices, and assisting peers when needed.
- Developed a reputation for exceptional attention to detail in claim reviews, ensuring accuracy at every stage of the process.
- Handled complex claims scenarios calmly under pressure, utilizing problem-solving skills to find appropriate resolutions swiftly.
- Maintained high-quality standards in claim handling by adhering to company policies and industry regulations.
- Assisted customers with completing insurance documents to avoid missed information.
- Delivered exceptional customer service to policyholders by communicating important information and patiently listening to issues.
- Read over insurance policies to ascertain levels of coverage and determine whether claims would receive approvals or denials.
- Conducted day-to-day administrative tasks to maintain information files and process paperwork.
- Investigated and assessed damage to property and reviewed property damage estimates.
- Reviewed police reports, medical treatment records, and physical property damage to determine extent of liability.
- Conducted comprehensive interviews of witnesses and claimants to gather facts and information.
- Determined liability outlined in coverage and assessed documentation such from police and healthcare providers to understand damages incurred.
- Maintained contact with claimants and attorneys to determine treatment status.
- Evaluated insurance claims by conducting thorough investigations and analyzing policy coverage.
Claims Service Representative (CSR)
GEICO
03.2016 - 06.2017
- DE/NC resident licensed adjuster
- Set up new losses
- Improved customer satisfaction by providing timely and accurate information on claim status and resolution.
- Maintained compliance with industry regulations by adhering to established procedures and guidelines in claims handling.
- Enhanced claim processing efficiency by streamlining workflows and implementing best practices.
- Conducted detailed assessments of claims documents, ensuring accuracy and completeness before submission for approval.
- Collaborated with internal departments and external vendors to resolve claims.
- Served as a subject matter expert on specialized claims, providing guidance and support to other team members when needed.
- Trained new Claims Representatives on company policies, procedures, and software systems, improving overall team productivity.
- Developed in-depth understanding of insurance policies and procedures.
- Provided exceptional customer service, addressing concerns and resolving issues promptly.
- Enhanced client satisfaction by efficiently processing claims within designated time frames.
- Delivered personalized customer service, addressing policyholder concerns and clarifying coverage details.
- Reduced claim resolution times with thorough documentation and timely follow-up.
- Verified client information by analyzing existing evidence on file.
- Posted payments to accounts and maintained records.
- Generated, posted and attached information to claim files.
- Maintained confidentiality of patient finances, records, and health statuses.
- Investigate and communicate liability decisions to all parties associated with claim
- Scheduled auto damage estimates and rental appointments
- Investigation for fraud potential and subrogation
Cashier/Server Trainer
Ryan's Buffet
06.2003 - 02.2016
- Greeted customers entering store and responded promptly to customer needs.
- Welcomed customers and helped determine their needs.
- Worked flexible schedule and extra shifts to meet business needs.
- Operated cash register for cash, check, and credit card transactions with excellent accuracy levels.
- Built relationships with customers to encourage repeat business.
- Maintained balanced cash drawer, ensuring accurate accounting at the end of each shift.
- Helped customers complete purchases, locate items, and join reward programs.
- Assisted customers with returns, refunds and resolving transaction issues.
- Counted money in cash drawers at beginning and end of shifts to maintain accuracy.
- Handled multiple payment methods securely, minimizing discrepancies and potential losses.
- Enhanced customer satisfaction by providing efficient and accurate cash transactions.
- Provided backup support for other departments when needed, showcasing versatility within the restaurant environment.
- Trained new team members on restaurant procedures, menu items, and performance strategies.
- Mentored new hires through the training process, ensuring they became productive team members quickly and efficiently.
- Demonstrated strong knowledge of food and beverage service standards and led by example to instill in new servers.
- Maintained cleanliness standards throughout dining areas, contributing to a positive dining experience for guests.
- Developed strong relationships with regular customers, encouraging repeat business and loyalty to the establishment.
- Enhanced customer satisfaction by providing efficient and friendly service during peak hours.
- Actively participated in team meetings to discuss strategies for increasing efficiency and improving customer experiences.
- Coached servers on proper food handling techniques to maintain compliance with health department regulations and uphold food safety standards.
- Implemented upselling techniques, boosting overall revenue for the restaurant.
- Provided feedback and guidance to help servers develop industry skills and knowledge.
- Utilized effective communication techniques to support server learning and comprehension.
- Coordinated with management to identify training needs, leading to more streamlined onboarding process for new hires.
- Demonstrated strong multitasking skills by managing multiple tables simultaneously without compromising service quality.
- Collaborated with team members during busy shifts for efficient workflow and excellent guest experiences.
- Addressed customer complaints or concerns professionally, ensuring swift resolution and maintaining positive relationships.
- Bussed and reset tables to keep dining room and work areas clean.
Education
Pending Associate Degree In Business Management - Business
Germanna Community College
Locust Dale, VADiploma -
Chancellor High School
Fredericksburg, VA06.2003
Skills
- Claims Handling
- Claims reports and documentation
- Presentation Skills
- Risk assessment skills
- Auto insurance regulations knowledge
- File management
- Customer Service
- Problem-solving abilities
- Time Management
- Attention to Detail
- Multitasking
- Reliability
- Organizational Skills
- Team Collaboration
REFERENCES
Available upon request
Timeline
Personal Injury Examiner (PIP Adjuster)
GEICO
04.2023 - Current
Independent Medical Exam Coordinator (IME)
GEICO
03.2019 - 09.2023
Telephone Claims Representative (TCR 1)
GEICO
06.2017 - 03.2019
Claims Service Representative (CSR)
GEICO
03.2016 - 06.2017
Cashier/Server Trainer
Ryan's Buffet
06.2003 - 02.2016
Pending Associate Degree In Business Management - Business
Germanna Community College
Diploma -
Chancellor High School
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