Annette Merritt-Davis
Columbus,GA
Summary
Diligent Claims Processor versed in insurance processes and claims procedures. Offers great attention to detail and time management abilities to successfully handle large volumes of claims. Highly accurate and thorough with a focus on completing error-free work in line with processing guidelines. Driven [Claim specialist] and customer service professional with insurance agency experience. Decisive negotiator and salesperson.
Overview
12
12
years of professional experience
1
1
Certification
Work History
Claim Associate-Express
State Farm Mutual Automobile Insurance Company
08.2023 - Current
- Delivers a remarkable customer experience throughout the handling of lower complexity claims, identifying and ensuring prompt routing of claims to other functional areas
- Receives and processes claim information, and communicates with internal and external customers via phone and other communication channels
- Works in a team environment and handles low complexity/high volume work in a contact/call center environment
- Successful completion of required training programs and licensing; continuing education for licensing
- Listen and communicate, professionally, and empathetically
- Work from established procedures and job aids and handle multiple computer applications while helping customers on the phone
- Educate customers on the claim process
- Escalate problems or inquiries as needed
- Maintain quality, accuracy, and professionalism in a fast-paced environment
- Ability to multi-task and adapt to changing environment
- Prior call center or customer service experience is preferred.
- Managed workload and priorities to meet claims processing meet deadlines.
- Utilized specialized software to process incoming claims, enter data and generate reports.
Claims Specialist
Progressive Causality Insurance
02.2021 - 08.2023
- Assemble facts, determine coverage, evaluate the amount of loss, analyze legal liability, make payments by coverage, damage, and liability determination, and perform other functions or duties to properly adjust the loss
- Study insurance policies, endorsements, and forms to develop an understanding of insurance coverage
- Follow claims handling procedures and participate in claim negotiations and settlements
- Deliver a high level of customer service to our agents, insureds, and others
- Devise alternative approaches to provide appropriate service, depending upon the circumstances
- Meet with people involved with claims, sometimes outside of our office environment
- Handle investigations by telephone, email, mail, and on-site investigations
- Maintain appropriate adjuster's license(s), if required by statute in the jurisdiction employed, within the time frame prescribed by the Company or statute
- Handle complex and unusual exposure claims effectively through on-site investigations and participation in mediations, settlement conferences, and trials
- Handle confidential information according to Company standards and under any applicable law, regulation, or rule
- Assist in the evaluation and selection of outside counsel
- Maintain punctual attendance according to an assigned work schedule at a company-approved work location.
- Followed up with customers on unresolved issues.
- Reviewed insurance and claims documents to verify required information and secure any missing data for settlements.
Customer Service Representative
Aflac
05.2019 - 01.2022
- Open and maintain customer accounts by recording account information
- Resolve product or service problems by clarifying the customer's complaint; determining the cause of the problem; selecting and explaining the best solution to solve the problem; expediting correction or adjustment; following up to ensure resolution
- Maintain financial accounts by processing customer adjustments
- Recommend potential products or services to management by collecting customer information and analyzing customer needs.
Forensic Service Technician
West Central Georgia Regional Hospital
07.2016 - 03.2019
- Provides training to individuals in a variety of areas depending upon the individual's needs
- Completes required documentation in the individual's and unit records
- Observes and maintains an awareness of individuals' behavior and physical whereabouts to ensure their security and safety
- Transports/accompanies individuals to appointments and activities in various locations and off-campus visits
- Participates in providing a safe, secure, clean, and attractive environment for individuals, visitors, and staff
- Provides assistance to other staff when admitting and orienting new individuals to units
- Conducts activities for recreation and socialization
- Provides clients with help walking, exercising, and moving in and out of bed
- Assist with identifying individuals in the medication line
- Assist with lab draws and the collecting of bodily fluid specimens
- Conducts environment rounds
- Participates in interdisciplinary treatment team
- Participates in crisis de-escalation
- Serves on hospital-wide committees
- Group facilitation.
Customer Service Representative II
American Home Shield
10.2015 - 07.2016
- Utilizes problem-solving skills to respond to and resolve routine customer service issues via inbound and outbound telephone calls, written correspondence, and/or electronic communication according to all company policies, standard operating procedures, and contract coverage
- Follows up with internal and external customers, contractors, and/or business partners to ensure customer service issues are resolved
- Maintains current knowledge of all company policies, procedures, & programs
- Responsible for effectively handling general customer service, pre-appointment, post-appointment, and payment services calls.
Customer Service Representative II
Wellpoint
01.2012 - 10.2015
- Responds to customer questions via telephone and written correspondence regarding insurance benefits, provider contracts, eligibility, and claims
- Analyzes problems and provides information/solutions
- Operates a PC/image station to obtain and extract information; documents information, activities, and changes in the database
- Thoroughly documents inquiry outcomes for accurate tracking and analysis
- Develops and maintains positive customer relations and coordinates with various functions within the company to ensure customer requests and questions are handled appropriately and in a timely manner
- Researches and analyzes data to address operational challenges and customer service issues
- Provides external and internal customers with requested information
- Under immediate supervision, receives and places follow-up telephone calls/e-mails to answer customer questions that are routine in nature
- Uses computerized systems for tracking, information gathering, and troubleshooting
- Requires limited knowledge of company services, products, insurance benefits, provider contracts, and claims
- Seeks, understands, and responds to the needs and expectations of internal and external customers
- Required to meet department goals.
Education
Diploma -
Central High School
01.2004
Skills
- Call Center
- CSR
- Data entry
- Clerical
- Social Perceptiveness
- Service Orientation
- Time Management
- Microsoft
- Medical Terminology
- Clerical experience
- Medical terminology
- Medical records
- ICD-10
- Hospital experience
- Task Prioritization
Certification
Property & Casualty License
Timeline
Claim Associate-Express
State Farm Mutual Automobile Insurance Company
08.2023 - Current
Claims Specialist
Progressive Causality Insurance
02.2021 - 08.2023
Customer Service Representative
Aflac
05.2019 - 01.2022
Forensic Service Technician
West Central Georgia Regional Hospital
07.2016 - 03.2019
Customer Service Representative II
American Home Shield
10.2015 - 07.2016
Customer Service Representative II
Wellpoint
01.2012 - 10.2015
Diploma -
Central High School
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