Nadia McCray
Glen Burnie
Summary
Detail-oriented claims specialist with extensive experience in data analysis and problem resolution. Known for ensuring compliance with state and federal regulations while maintaining exceptional client relations. Eager to leverage expertise to drive operational excellence in a dynamic environment.
Overview
10
10
years of professional experience
Work History
Auto Services Consultant
Progressive
07.2025 - Current
- Identify and flag policies that did not pass initial underwriting markers
- Communicate electronically with state Department of Motor Vehicles on behalf of the customer
- Create documents to show proof of insurance and validate coverage
- Change coverages on policies and educate customers on state guidelines for minimums and maximum coverage thresholds
- Resolved customer complaints through effective communication and problem-solving.
Agency Resource Representitive
Cigna
08.2024 - 07.2025
- Maintain agent records to verify they are up to date with compliance to enable agents to sell Cigna Medicare
- Receive incoming calls from agents about their license and or business status with Cigna
- Update agents on the status of their clients Medicare application
- Go over underwriting decisions for declining Medicare applications
- Logged accurate records of client and agent interactions and transactions
- Review federal insurance compliance and uphold state jurisdictions
Benefit Advisor & Leave Eligibility Specialist
UNUM
03.2022 - 08.2024
- Make leave eligibility decisions based on employer contract and the leave type claimant was applying for
- Abide by employer, state, and federal laws to ensure FMLA and Disability benefits were given fairly
- Communicate and guide applicants through leave process
- Reviewed medical documents from doctors' office for disability leave to determine that illness was covered under policy
- Calculate and distribute wage payouts
- Coordinate with physician office, claimant and management a return-to-work date based on medical evaluation
Medical Claims Examiner
First Financial Asset Management 360
09.2021 - 03.2022
- Investigated discrepancies in claims data, reconciled errors, and corrected inaccuracies as needed
- Analyzed provider contracts to ensure proper reimbursement levels were achieved
- Identify claims that were associated with motor vehicle accidents and contact auto liability carrier to get payment status of claims
- Initiate liens on accounts that meet guidelines for being high risk of non-payment
- Endorse contractual obligations for payments with different health insurance companies
- Negotiate with various attorneys and law agencies to come to an agreement on settlements
- Submitted appeals to payers when necessary to resolve denied or underpaid claims.
- Reviewed and processed medical claims for accuracy and completeness according to established guidelines.
Initial Loss Reporting And Claims Associate
State Farm
07.2019 - 09.2021
- Accurately gather and document loss information for the initiation of new claims and established claims
- Evaluate and establish liability decisions based on facts, policy limits and state jurisdictions
- Communicate with claimants and third-party legal teams to reach fair legal settlements
- Use decrement to determine if there were any fraud indicators on claims and escalate to internal investigation team as necessary
- Review medical records and bills to confirm that medical treatment received was related to auto accident and viable to claim payment
- Responded to inquiries from regulatory bodies and complied with reporting requirements.
- Coordinated with repair facilities and contractors to obtain repair estimates and ensure quality services.
Guest Advocate Team Lead
Target
10.2016 - 07.2019
- Identified and implemented improvements in operational processes on sales floor and among employees, enhancing overall efficiency
- Uphold schedules of team members to ensure they take their breaks and lunches to comply with state employer guidelines
- Completed several audits of cash registers to certify that cash transactions were being maintained with integrity
- Collaborated with team leads and store associates to achieve and exceed sales goals, fostering a cohesive team environment
- Complete store displays as they are assigned by regional campaign managers and business partners
- Handle customers' dissatisfaction and complaints with empathy and haste
Education
Associate of Science - Public Health
Anne Arundel Community College
Arnold, MD05-2028
High School Diploma -
Mount Tahoma
Tacoma06-2009
Skills
- Claims processing
- Regulatory compliance
- Data analysis
- Effective communication
- Client relationship building
- Report Creation
- File Management
- Clear Communication
- Ethical Practices
- Multitasking Capabilities
- Policy Implementation
Timeline
Auto Services Consultant
Progressive
07.2025 - Current
Agency Resource Representitive
Cigna
08.2024 - 07.2025
Benefit Advisor & Leave Eligibility Specialist
UNUM
03.2022 - 08.2024
Medical Claims Examiner
First Financial Asset Management 360
09.2021 - 03.2022
Initial Loss Reporting And Claims Associate
State Farm
07.2019 - 09.2021
Guest Advocate Team Lead
Target
10.2016 - 07.2019
Associate of Science - Public Health
Anne Arundel Community College
High School Diploma -
Mount Tahoma