Jason Maxwell Samson
Short Term Insurance Consultant
Witbank
Summary
I completed High school in 2012. Got a job at Amadwala Risk Solutions on the 01/07/2023 started working in the Short term insurance department and currently still working at Amadwala Risk Solution for the past 11 years.
Have worked in the following departments:
Done underwriting of policies for 4 years.
Doing claims for the past 7 years.
Overview
10
10
years of professional experience
Work History
Claims Specialist
AMADWALA RISK SOLUTIONS
Witbank
07.2013 - Current
- Conducted full claim investigations and reported updates and legal actions.
- Escalated files with significant indemnity exposure to supervisor for further investigation.
- Reviewed new files to determine current status of injury claim and to develop plan of action.
- Followed up with customers on unresolved issues.
- Utilized appropriate cost containment techniques to reduce overall claim costs.
- Provided advice to customers regarding claims, rights and insurance processes to prevent disputes.
- Negotiated with other involved parties to arrange settlements for maximum results.
- Reviewed insurance and claims documents to verify required information and secure any missing data for settlements.
- Conducted risk evaluations on claims settlement proposals to encourage sound decision-making regarding settlement offers.
- Understood requirements for disputes, gathered evidence to support claims and prepared customer cases to handle appeals.
- Monitored compliance with regulations and industry best practices to promote fair and proper treatment for insured customers.
- Modified, updated and processed existing policies.
- Made contact with insurance carriers to discuss policies and individual patient benefits.
- Collected premiums and issued accurate receipts.
- Coordinated with contracting department to resolve payer issues.
- Posted payments to accounts and maintained records.
- Assured timely verification of insurance benefits prior to patient procedures or appointments.
- Communicated effectively with staff members of operations, finance and clinical departments.
- Verified client information by analyzing existing evidence on file.
- Generated, posted and attached information to claim files.
- Maintained strong knowledge of basic medical terminology to better understand services and procedures.
- Calculated adjustments, premiums and refunds.
- Checked documentation for accuracy and validity on updated systems.
- Processed and recorded new policies and claims.
- Determined appropriateness of payers to protect organization and minimize risk.
- Notified insurance agents and accounting departments of policy cancellations and changes.
- Carried out administrative tasks by communicating with clients, distributing mail, and scanning documents.
- Prepared insurance claim forms or related documents and reviewed for completeness.
- Performed administrative duties by verifying documentation, researching facts and contacting other parties involved to determine fault percentages and minimize potential losses.
Education
No Degree -
Hoërskool Generaal Hertzog
Witbank 04.2001 - 04.2012
Skills
Coverage assessments
Settlement determinations
Documentation review
Claims
Insurance industry experience
Insurance coverage verification
Data integrity
Documentation abilities
Reporting skills
Flexible and Adaptable
Excellent administrative abilities
Teambuilding
Certification
MARITAL STATUS : SINGLE
Additional Information
- PERSONAL DETAILS: SURNAME: : SAMSON NAME: : JASON SAMSON IDENTIFICATION NUMBER : , 940520 5148 08 5
Timeline
Claims Specialist
AMADWALA RISK SOLUTIONS
07.2013 - Current
No Degree -
Hoërskool Generaal Hertzog
04.2001 - 04.2012