Cory Vincent Price
Nashville
Summary
. Claims professional who values precision and efficiency in claims evaluation and resolution. Proven track record of managing high caseloads and settling claims accurately in compliance with company standards. Known for strong collaboration with team members and adaptability to changing needs, ensuring reliable performance and positive results.
Overview
20
20
years of professional experience
1
1
Certification
Work History
Claims Adjuster
State Farm
07.2023 - Current
- Investigate and assess bodily injury claims by reviewing medical records, accident reports, and witness statements
- Evaluate the extent of injuries and determine the appropriate level of compensation based on policy coverage and liability
- Collaborate with medical professionals, claimants, attorneys, and third-party service providers to ensure thorough claims investigation
- Successfully negotiate settlements with claimants and attorneys, resolving claims efficiently while minimizing litigation costs
- Managed a caseload of 270-300 claims, adhering to company deadlines and regulatory requirements
- Regularly update claimants on case progress, ensuring clear communication and strong customer service throughout the claims process
Care Coordinator
Long Term Care Group
09.2010 - 10.2023
- Assess benefit eligibility and provider eligibility for long term care policy holders by reviewing policy triggers, medical records, and billing from all current providers
- Provided care coordination to 200 caseloads per month, of adult population diagnosed with dementia, Alzheimer’s, and other chronical and terminal diseases
- Develop and implement training manuals for the Care Management Department; provide on-site training for Care Management Support new hires
- Generate daily claims reports and track trends for the Care Management Department
- Ensure successful claim outcomes by achieving prompt claim closures, high client satisfaction with claim services, effective claim cost containment
- Communicate with the insured, insured's representative or provider to follow-up on information needed to process outstanding claims
- Perform all functions through the initial review of the onboarding process to assure that Independent Caregivers, Home Health Care Agencies and Skilled Nursing Facilities meet the Long-Term Care plan's requirements for care as a contracted provider
Premium Auditor
EXL Service
11.2020 - 07.2023
- Perform audits on Property/Casualty Commercial Lines adjustable policies to establish appropriate classifications, exposures, and basis of premium
- Responsible for developing premium exposures in accordance with company, industry and government rules and regulations
- Audits may be conducted both in person as well as virtually
- Conducts audit of selected Commercial Lines adjustable policies by reviewing the insured's business operation, including examining, verifying, and recording pertinent classification-related data from financial/business records
- Determines and/or develops premium basis and classification
- Conducts physical and virtual audits to optimize timeliness and productivity
- Discuss issues and problems with the insured to ensure understanding of the change in premium exposures and to maintain good customer relations
- Ensure quality of the audit through proper risk classification and exposure basis information
- Utilizes laptop computers to record audit information and transmit complete audits in a timely manner
- Provides external customers (i.e., agents and insurers) and internal customers (i.e., underwriting, policy processing, claims and accounting) with information to assist in their understanding of audit-related matters, including audit vouchers, procedures, and worksheets
- Remains informed of changes and current information relative to premium auditing through discussion and correspondence with experts and industry-related literature
- Responsible for alerting the Special Investigative Unit (SIU) to potential fraud situations
Manager
Gap Inc.
11.2004 - 07.2016
- Directly lead and supervised 30-45 sales associates; including planning, assigning, prioritizing and follow-up to ensure proper execution of all workloads in both customer and branding divisions
- Reviewed all weekly and monthly reports pertaining to store, customer service, staff training progression, shrinkage and register training, to maximize sales and profit
- Developed and executed floor changes and marketing elements to drive business and increase sales
- Interviewed and hired sales associates
- Developed plans to monitor all controllable cost/expenses of a 4-million-dollar volume store
- Coached sales associates to improve and maximize their performance, as well as develop sales associates to advance within the company, through Gap Inc.'s business vision for the company
Healthcare Collector
Community Health Systems
01.2011 - 08.2012
- Determined and initiated actions to resolve rejected Medicare and Commercial claims; prepare corrections and payer appeals using electronic and/or paper process
- Utilized NaviNet to determine patient's eligibility, benefits, and health plan confirmation
- Communicated with insurance companies and patients to resolve claim processing issues
- Printed rebills from the facility system to mail and/or to fax to insurance companies and third-party payers
Benefits Representative
Blue Cross Blue Shield of Tennessee
10.2009 - 01.2011
- Responded to client questions via telephone and written correspondence regarding insurance benefits, provider contracts, eligibility, and claims
- Operated PC/Image station and FACETS system to obtain and extract information, documents information, activities, and changes in the database
- Provided on-going education via written or verbal responses to clients to clarify Blue Cross Blue Shield of Tennessee position regarding company policies and procedures
- Researched and resolved incorrect payments, EOB rejections and other issues with clients' claims
- Insured accuracy of claims
- Verified correct ICD-9 and CPT codes for a variety of specialties
Education
Bachelor - Computer Information Systems
Ashworth College
Associates - Healthcare Administration
Volunteer State Community College
Skills
- Data Analysis
- Operational Records Maintenance
- Employee Training Program
- HIPAA Guidelines
- Patient Care Assessment
- Casualty and property loss
- Litigation resolution
- Claims negotiation
- Claims investigations
- Settlement management
- Risk Assessment
Certification
Connecticut, CA-All-Lines, License#20802592
Delaware, Causality and Property, License#3002797467
Florida, General Lines, License#G033453
Georgia, Adjuster Auto and Fire, License#2024
Kentucky, Property and Causality, License#DOI-1297227
Louisiana, Property and Causality, License# 1081645
New Hampshire, Property and Causality, License# 20802592
New Mexico, Staff Adjuster, License#20802592
Rhode Island, Property and Causality, License# 3002686110
South Carolina, Property and Causality, License# 20802592
Texas, Adjuster-All-Lines, License# 3092989
Vermont, Property and Causality, License# 3002794046
Timeline
Claims Adjuster
State Farm
07.2023 - Current
Premium Auditor
EXL Service
11.2020 - 07.2023
Healthcare Collector
Community Health Systems
01.2011 - 08.2012
Care Coordinator
Long Term Care Group
09.2010 - 10.2023
Benefits Representative
Blue Cross Blue Shield of Tennessee
10.2009 - 01.2011
Manager
Gap Inc.
11.2004 - 07.2016
Bachelor - Computer Information Systems
Ashworth College
Associates - Healthcare Administration
Volunteer State Community College
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