. Analytical problem-solver with excellent communication skills. Effective at interviewing claimants, compiling records and documenting findings. Well-versed in insurance policies, practices and standards.
Overview
18
18
years of professional experience
1
1
Certification
Work History
Claims Representative
HUMANA INC
Desoto, TX
07.2020 - Current
Process member and provider claims via telephone and email
Modify/update existing claims and obtain information from policyholders to verify accuracy of their accounts
Contacted all parties involved to obtain statements, provide claim details, and answer questions regarding claims process
Provide ordered, structured, and focused management attention to member’s problems in order to gain complete client satisfaction
Developed and maintained reporting procedures for tracking the effectiveness of various programs
Analyzed and managed claim files within the unit
Supervise and motivate staff by encouraging creativity and delegating tasks appropriately, establishing and adhering to action plans in claims files, and providing effective negotiation and appropriate resolutions.
Examined reports, accounts, and evidence to determine integrity and accuracy of information.
Interviewed policyholders to verify information and obtain additional details.
Worked productively in a fast-moving work environment to process large volumes of claims.
Updated claims system to track claim status and provide relevant information to other departments.
Prepared and presented detailed reports to management on claims issues to aid in decision-making.
Followed up with customers on unresolved issues.
Associate - Contractor Sales
LOWES HOME IMPROVEMENT
Desoto, TX
10.2017 - Current
Fostered lasting relationships with customers through effective communication and quick response, resulting in long-term loyalty and expanded client base.
Stayed current on company offerings and industry trends.
Performed effectively in self-directed work environment, managing day-to-day operations and decisions.
Achieved or exceeded company-defined sales quotas.
Identified new business opportunities through cold calling, networking, marketing and prospective database leads.
Increased sales with execution of full sales cycle processing from initial lead processing through conversion and closing
Met with customers to discuss and ascertain needs, tailor solutions and close deals
Collaborated with managers to provide customer feedback and recommend operational changes to meet emerging trends
Trained new employees on customer service, money handling and organizing strategies
Materials Management Coordinator
VIBRA SPECIALITY HOSPITAL
DeSoto, TX
02.2011 - 07.2020
Kept documentation and records accurate and up-to-date with latest data to prevent errors in processing or delivery.
Completed physical inventory counts each month.
Recorded information, shortages, and discrepancies to keep records current and accurate.
Performed data entry and completed proper paperwork.
Developed materials to educate staff on proper inventory management techniques.
Monitored and adjusted inventory levels to meet customer needs and demands.
Collaborated with procurement team to establish steady supply of inventory.
Completed stock inventories to identify and address issues negatively impacting controls.
Maintained and organized inventory receipts and processed changes to reduce process lags.
Implemented systems for tracking and managing stock levels with accuracy and precision.
Analyzed inventory trends to identify and prepare for potential issues and discrepancies.
Researched and compiled information on variety of planning issues from multiple sources, prepared thorough reports and presented findings in daily meetings
CUSTOMER SERVICE/SALES ASSOCIATE
THE HOME DEPOT, INC
Duncanville , TX
01.2005 - 01.2011
Provided fast and friendly service by actively seeking out customers to assess their needs and aided accordingly.
Maintained in-stock condition of assigned areas, and ensured that it was clean, and safe for customers to shop.
Maintained working knowledge of various products in assigned area.
Provided information on product features and related to items related to vendor projects.
Helped customers locate products and checked store system for merchandise at other sites
Maintained calm demeanor and professionally managed issues in busy, high stress situations.