Summary
Overview
Work History
Education
Skills
Certification
Timeline
Volunteer
Generic

Candice Roberson

Jacksonville,FL

Summary

A Senior Claims Analyst and Implementation Manager with 21 years of experience successfully leading diverse teams and driving seamless execution of complex projects, including investigating, evaluating, and negotiating claim settlements. Proficient in project management methodologies, adept at identifying business requirements, and skilled in implementing customized solutions to optimize organizational and department operations. Demonstrates exceptional communication skills, fostering strong client relationships and delivering tangible results to drive business growth and client satisfaction. Detail-oriented team player and self-starter with strong organizational skills. Ability to handle multiple projects simultaneously with a high degree of accuracy.

Overview

21
21
years of professional experience
1
1
Certification

Work History

Senior Claims Analyst

Allstate
01.2015 - Current
  • Responsible for assisting in developing and monitoring claim policy, standards, procedures, and strategy
  • Train, coach, and develop team members to improve performance
  • Investigate, evaluate, and negotiate settlement of claims to promote retention
  • Finalize claims process for payment and maintain claims adjudication workflow, reconciliation, and quality control measures to meet and exceed payment guidelines
  • Document all significant activities in claim file, establishing best practices, procedures, and applicable state regulations
  • Assign correct provider for proper payment
  • Manage Claims Database
  • Determines policy parameters such as periods, coverages, and deductibles
  • Interprets policy language and other legal documents
  • Obtain medical records relating to claim
  • Provides successful claims adjustment and exceptional customer service to internal and external customers
  • Pursue education to enhance industry knowledge
  • Work productively and harmoniously with others consistently
  • Review and update manuals and make applicable revisions
  • Prepare Metric Reports
  • Follow all HIPAA and compliance guidelines
  • Projects as assigned.
  • Improved customer satisfaction by consistently resolving complex claims in a timely and professional manner.

Implementation Manager and Senior Team Lead

Allstate
10.2003 - 01.2015
  • Supervised four to six front-line associates
  • Assist in recruitment process for account representatives including reviewing resumes and interviewing to identify potential candidates
  • Trained, Coached, Mentored, and evaluated Implementation Specialist progress
  • Trained Agents
  • Researched and resolved client inquiries for system and process issues
  • Consulted clients on best practices, necessary systems, and process changes to achieve client goals
  • Worked with all relevant internal IT departments to serve as a voice of end-user for technology and functionality
  • Worked with internal and external groups to understand operational and business requirements, applicable technologies, products, and services, and contractual obligations to meet customer needs and obligations
  • Worked to ensure seamless transition from implementation to initiative to post-implementation of project, managing customer expectations and satisfaction
  • Gathered and maintained documentation and system technology requirements
  • Provided quality assurance and production support of systems
  • Troubleshoot and resolve customer issues through technical guidance and support to customers, maintaining accurate records of customer interactions
  • Analyzed complex processes and procedures to implement creative solutions for problem-solving
  • Captured and created all related project implementation documentation to guide all employee’s post-implementation to ensure smooth customer transition into maintenance cycle
  • Developed and maintained positive relationships with customers
  • Participated in training and development opportunities to enhance knowledge and skills
  • Reviewed course material and recommend changes
  • Regularly assess quantity and quality of work produced by account representatives, provide feedback to ensure maximum quality and production levels; regularly monitor service level and provide feedback ensure service level goals are met
  • Kept current with emerging technologies, industry trends, standards, and regulations
  • Recorded monthly progress of individual clients toward treatment objectives and daily activities, providing valuable input during case analysis and treatment plan discussions among colleagues, leading development of personalized and impactful treatment strategies.

Education

B.S. Degree -

Florida State College of Jacksonville
Jacksonville, FL

A.A. Degree -

Bakersfield College
Bakersfield, CA

Skills

  • Supervisor and Trainer
  • Retail Sales Experience
  • Claims Examiner
  • Customer Service
  • Training and Development
  • Collections
  • Data Entry
  • Inventory and Record Keeping
  • Typing
  • Medical Terminology
  • Billing
  • Front Office Assistant
  • Microsoft Office, Microsoft Word, Microsoft Excel, Microsoft Teams
  • PowerPoint
  • Zoom
  • Project Management
  • Fraud detection techniques

Certification

Certified Notary Public, Florida, 2025-01-01

Timeline

Senior Claims Analyst

Allstate
01.2015 - Current

Implementation Manager and Senior Team Lead

Allstate
10.2003 - 01.2015

B.S. Degree -

Florida State College of Jacksonville

A.A. Degree -

Bakersfield College

Volunteer

P.A.C.E Center for Girls-2024 (Facilitated Resume Building)

Jim Dotson Foundation-2024 (Collaborated Can Food Drive)

Boys Scouts of America-2023( Renovated Club House)

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Candice Roberson