Amethyst Guyton
Milledgeville,GA
Summary
Dynamic customer service professional with extensive experience at GEICO, excelling in problem-solving and conflict resolution. Proven track record in insurance verification and claims processing, fostering strong client relationships. Adept at utilizing CRM software to enhance service delivery, consistently achieving high satisfaction levels through effective communication and de-escalation techniques.
Overview
30
30
years of professional experience
1
1
Certification
Work History
Customer Service Rep (Remote Contractor)
Maryland Department Of Human Services (NexRep)
Milledgeville, GA
12.2024 - Current
- Resolved complex customer issues through effective communication and problem-solving techniques.
- Maintained comprehensive records of all customer interactions for future reference.
- Investigated product quality complaints to identify areas for improvement and enhance service.
- Developed strong customer relationships by delivering personalized assistance and support.
- Answered inquiries via phone, email, and chat, ensuring timely responses.
- De-escalated challenging situations with a calm, professional demeanor to maintain satisfaction.
- Promoted high customer satisfaction through knowledgeable, friendly service during interactions.
- Maintained current knowledge of company offerings and policies to provide accurate information.
Medical Service Rep (Remote Contractor)
Teladoc (NexRep)
09.2024 - 12.2024
- Answered high volume of incoming calls, directing patients to appropriate departments promptly.
- Maintained organized filing system for patient records according to HIPAA regulations.
- Entered patient data into electronic health record systems per established procedures.
- Scheduled appointments, coordinated referrals, and ordered tests as needed.
- Verified insurance coverage to determine patient eligibility for services.
- Facilitated communication between patients, medical providers, and pharmacies effectively.
- Processed payments and maintained accounts receivable records, generating reports as necessary.
- Guided patients through consent forms and other required documentation.
Medicaid Billing Specialist (Remote Contractor)
AmeriHealth Caritas Family of Companies (Liveops)
Milledgeville, GA
06.2024 - 12.2024
- Coordinated cross-departmental communication to address billing issues and concerns.
- Performed quality assurance checks on submitted documents before processing.
- Verified patient insurance coverage to ensure accuracy of financial data.
- Reviewed and processed Medicaid claims for compliance and accuracy.
- Adhered to HIPAA regulations while managing protected health information.
- Processed appeals on denied claims to maximize reimbursements from third-party payers.
- Researched billing discrepancies to resolve issues and identify improvement areas.
- Developed strong professional relationships with vendors and clients.
Patient Assistance Representative (IC-Remote)
Regalo (LiveOps)
Milledge, GA
10.2023 - 06.2024
- Resolved customer complaints with professionalism and empathy, maintaining high satisfaction levels.
- Answered product and service inquiries promptly to enhance customer experience.
- Established strong relationships through effective communication techniques.
- Escalated unresolved issues to relevant departments for swift resolution.
- Demonstrated strong problem-solving skills when addressing complex customer inquiries.
- Greeted customers warmly and responded to inquiries in a timely manner.
- Consistently achieved daily performance goals set by management team members.
- Exhibited exceptional service skills by exceeding customer expectations in all interactions.
Claims Representative (Remote Contractor)
Allstate (Liveops)
Milledgeville, GA
11.2020 - 10.2023
- Investigated claims facts, confirmed coverage and liability, and negotiated settlements.
- Processed high volumes of claims efficiently while adhering to quality standards.
- Maintained detailed records of communications with customers, claimants, and internal departments.
- Provided clear explanations of benefits and eligibility requirements to customers.
- Documented changes in claim statuses using specialized software systems.
- Handled customer inquiries regarding policy coverage and payment status updates.
- Adhered to confidentiality guidelines when managing sensitive personal information.
- Assisted claimants and providers with questions or problems related to claims.
Licensed Casualty, Property and Medical Adjuster
GEICO
Macon, GA
04.1998 - 06.2018
- Investigated insurance claims to determine liability and damages.
- Evaluated subrogation opportunities to identify recoverable funds.
- Drafted correspondence related to claim investigations and settlements.
- Negotiated settlements with claimants, attorneys and other parties.
- Assessed potential losses for insureds in accordance with applicable laws and regulations.
- Ensured compliance with regulatory requirements relating to claims handling.
- Coordinated activities between multiple departments within the company.
- Maintained detailed records of all claim activities in a timely manner.
- Reviewed property damage estimates for accuracy and completeness.
- Established reserves for each claim based on analysis of the facts and applicable law.
- Developed relationships with clients, underwriters, adjusters, brokers and other internal and external stakeholders.
- Participated in training sessions related to new policies or procedures.
- Provided coverage opinions based on analysis of facts, law, policy language and endorsements.
- Demonstrated excellent communication skills when interacting with customers.
- Documented date, parties involved and specific details about incidents.
- Conducted witness interviews to assist claim information gathering process.
- Discovered occurrences of insurance fraud or criminal neglect to avoid workplace liability.
- Resolved claims for insureds by providing relevant policy details and excellent customer service.
- Identified and obtained evidence to ascertain claim value.
- Reviewed and applied state laws and regulations to ensure compliance in claim handling.
- Utilized claim handling software to document and manage claim files efficiently.
- Investigated and evaluated property and casualty insurance claims to determine coverage and liability.
- Analyzed and audited open claims to calculate additional payments owed.
- Worked closely with repair facilities and contractors to ensure quality repairs for policyholders.
- Coordinated with medical professionals to assess injury claims and determine compensation.
- Gathered information from various third parties to determine claim acceptability.
- Engaged in continuous learning to stay current with industry trends and best practices in claims management.
- Reviewed, evaluated and adjusted claims to promote fair and prompt settlement.
- Participated in training and mentoring of new claims adjusters, sharing knowledge and expertise.
- Coordinated with law enforcement and other agencies as needed for claims investigation.
- Resolved claim disputes through mediation and negotiation, minimizing the need for litigation.
- Negotiated and settled claims according to information presented through reports, research, and data verification.
- Prepared detailed reports on investigation findings and claim status for internal use.
- Explained premiums owed to policyholders, agents and underwriters.
- Analyzed and determined fault in auto accidents based on evidence and applicable laws.
- Calculated and authorized payment of claims within designated authority level.
- Assisted in fraud detection and prevention efforts by identifying suspicious claim activities.
- Negotiated settlement of claims with claimants and attorneys to ensure fair outcomes.
- Interpreted insurance policy language to apply appropriate coverage.
- Investigated questionable claims to determine payment authorization.
- Interviewed claimants, medical specialists and employers to determine pertinent claim information.
- Checked into questionable claims, interviewing agents and claimants to resolve errors and omissions.
- Reduced loss ratios through fair and prompt processing of claims.
- Investigated potentially fraudulent claims with focus on thoroughness, quality, and cost control.
- Explained loss coverage, assisted policyholders with itemizing damages and coordinated alternative living arrangements.
- Reviewed policies to determine appropriate levels of coverage and assist with approval or denial decisions.
- Discussed current cases and issues in claim committee meetings.
- Reviewed police reports, medical treatment records, medical bills and physical property damage to determine extent of liability.
- Verified liability extent with reviews of police reports, medical treatment histories and other records.
- Conducted secondary evaluations of original investigations documentation and reports to facilitate smooth resolutions.
- Input claim information and payments into company database.
- Analyzed information gathered by investigations and reported findings and recommendations.
- Delivered exceptional customer service to clients by communicating information and actively listening to concerns.
Call Center Trainer
Cox Communications
Macon, GA
06.1995 - 04.1998
- Researched customer service best practices and shared insights with colleagues.
- Participated in meetings with senior management to address call center challenges.
- Assisted in developing policies to ensure compliance with call center standards.
- Monitored calls in real-time to assess training program effectiveness.
- Provided feedback on employee performance post-training to supervisors.
- Evaluated trainees' progress through quizzes and exams after each session.
- Identified training needs based on supervisor feedback and monitored calls.
- Designed and conducted training sessions on customer service, problem-solving, and sales techniques.
Education
High School Diploma -
Central High School
Macon, GA06-1986
Some College (No Degree) - Information and Communication Technology
Middle Georgia State University
Macon, GAMedical Billing And Coding
Central Georgia Technical College
Macon, GASkills
- Problem solving and conflict resolution
- Data entry and record keeping
- Insurance verification and claims processing
- HIPAA compliance
- Time management
- Customer relationship management
- Rapport building and de-escalation
- Call center operations
- Verbal and written communication
- CRM software expertise
- Microsoft Office proficiency
- Remote and in-person experience
Certification
- I was a Licensed Agent and Adjuster for the state of Georgia for almost 20 years.
- As a trainer my company was Number 1 in customer service. We frequently won the JD Power Award.
- Medical Terminology Certificate
Accomplishments
- Exceeded corporate target for customer satisfaction for 20 years at GEICO and presently.
- Out of almost 300 agents in my department, I received an award for the highest customer service surveys.
- Quickly and efficiently filed claims on behalf of insureds and claimants while creating empathy.
- Effectively assisted customers with policy coverage and questions.
Languages
English
Professional
Affiliations
- I am currently studying again for the Comptia exams.
- I have resumed my studies of Spanish.
- I am heavily involved in my Christian ministries and community.
References
References available upon request.
Timeline
Customer Service Rep (Remote Contractor)
Maryland Department Of Human Services (NexRep)
12.2024 - Current
Medical Service Rep (Remote Contractor)
Teladoc (NexRep)
09.2024 - 12.2024
Medicaid Billing Specialist (Remote Contractor)
AmeriHealth Caritas Family of Companies (Liveops)
06.2024 - 12.2024
Patient Assistance Representative (IC-Remote)
Regalo (LiveOps)
10.2023 - 06.2024
Claims Representative (Remote Contractor)
Allstate (Liveops)
11.2020 - 10.2023
Licensed Casualty, Property and Medical Adjuster
GEICO
04.1998 - 06.2018
Call Center Trainer
Cox Communications
06.1995 - 04.1998
High School Diploma -
Central High School
Some College (No Degree) - Information and Communication Technology
Middle Georgia State University
Medical Billing And Coding
Central Georgia Technical College
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