Briyana Williams
4615 Media Meadow,TX
Summary
Dedicated and versatile professional with extensive experience spanning auto claims, telephone sales, care coordination, eligibility representation, and service acquisition. Proven track record of success in assessing auto insurance claims, conducting effective outbound sales, coordinating care for individuals, managing eligibility processes, and facilitating service acquisition. Skilled in providing exceptional customer service, addressing inquiries, and resolving issues promptly and efficiently. Strong communication, problem-solving, and multitasking abilities. Committed to delivering outstanding results and exceeding expectations in diverse roles and fast-paced environments.
Overview
7
7
years of professional experience
1
1
Certification
Work History
Auto Claims Specialist
Allcat Claims Service
03.2023 - 11.2023
- Provide auto claims service via internal channels (phone/email/fax/mail/other electronic channels) to clients and third parties
- Reviews coverage and liability associated with an auto claim and understand the application of both to the claim presented to ensure coverage owed
- Understand the end to end process of an auto claim and handles specific claim tasks as required to assist with advancing a claim forward efficiently and accurately to include payment of claim
- Use critical thinking and detailed analysis to understand what is owed and advance claim forward through documentation, diary adjustments, and/or communication
- Contact parties involved in the loss as necessary to resolve auto claim
- Follow provided steps in a statement of work provided and gain efficiency through handling a repeatable and continuous process
- Clearly document thought process, investigation, evaluation, negotiation and settlement decisions as necessary based on the claims process being handled
- Prioritize and manage assigned claims worklist
- Collaborate and support team members to resolve issues and identify appropriate matters for escalation
- Acquire and apply basic knowledge of Property & Casualty insurance industry products, services, and processes to include P&C insurance policy contracts and coverages and the claim handling process and procedures
- Ability to maintain discretion in business relationships and exercise sound business judgement
- Support workload surges and/or Catastrophe operations as needed.
Care Coordinator
90 Degree Benefits, Inc.
10.2022 - 02.2023
- Respond to and provide a high level of consumer education to members and customers regarding inquiries on eligibility, benefits, and claim status with a high level of accuracy
- Maintain established service levels with respect to occupancy/ availability time, first call resolution, and production on a consistent basis, without sacrificing quality
- Educate consumers and providers on the use of electronic portal solutions and websites for direct access to benefit questions, claim status, etc
- Make outbound calls on the member's behalf to various Providers or other entities in order to help coordinate care or resolve claim/ benefit questions
- Utilizes appropriate tools and resources to answer and document all customer inquiries
- Identifies and makes recommendations on process improvement opportunities
- Works and supports the team environment in order to meet both individual and team objectives
- Escalates more advance problems or inquiries to team lead or manager, as appropriate
Service and Acquisition Specialist
Victory Capital
02.2022 - 09.2022
- Deliver best in class guidance and service to members/clients
- Ability to retain and nurture relationships
- Educate potential and existing members/clients about investment products and services
- Maintain current knowledge of Victory products, policies and services while keeping abreast of financial markets and regulations
- Deliver on performance goal;s by uncovering additional client needs and deepening existing relationships
- Servicing more members, acquiring new members and meeting more member needs
Telephone Sales Representative
Connexion Point
11.2020 - 05.2021
- Responsible for handling inbound calls dealing with Medicare and Medicaid members
- Ask probing questions to find out what plan is the best fit for member
- Work with other departments on cross functional tasks and projects
- Maintain performance and quality standards based on established call center metrics
Customer Service Representative
Centene
08.2017 - 08.2020
- Reference current materials to answer escalated and complex inquiries from members and providers regarding claims, eligibility, covered benefits and authorization status matters
- Provide assistance to members and/or providers regarding website registration and navigation
- Educate members and/or providers on health plan initiatives Provide first call resolution working with appropriate internal/external resources, and ensure closure of all inquiries
- Document all activities for quality and metrics reporting through the Customer Relationship Management application
- Research and identify processing inaccuracies in claim payments and route to the appropriate team for claim adjustment
- Work with other departments on cross functional tasks and projects
- Maintain performance and quality standards based on established call center metrics including turn around times
Sales Associate
Alorica
07.2016 - 05.2017
- Responsible for making outbound calls
- Probing questions to find out what lead the customer to disconnect services
- Listen to customers' concerns and assist with the customers needs
- Finding solutions to keep the customer to stay with DIRECTV
Education
Diploma -
Lamson Institute
09.2022
High School Diploma -
John Marshall High School
06.2014
Skills
- Customer service
- Leadership
- Inside sales
- Cold calling
- Insurance sales
- Typing
- Customer relationship management
- Microsoft Access
- Research
- Negotiation
- Telemarketing
- Sales
- Communication skills
- Organizational skills
- Microsoft Office
Certification
- Certified Medical Assistant
- Property & Casualty License
Timeline
Auto Claims Specialist
Allcat Claims Service
03.2023 - 11.2023
Care Coordinator
90 Degree Benefits, Inc.
10.2022 - 02.2023
Service and Acquisition Specialist
Victory Capital
02.2022 - 09.2022
Telephone Sales Representative
Connexion Point
11.2020 - 05.2021
Customer Service Representative
Centene
08.2017 - 08.2020
Sales Associate
Alorica
07.2016 - 05.2017
Diploma -
Lamson Institute
High School Diploma -
John Marshall High School
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