Constance Melton
Wimauma,FL
Summary
Results-driven claims manager with expertise in claims analysis, regulatory compliance, and process optimization. Demonstrated ability to lead teams in surpassing performance goals while improving operational efficiency. Proven track record of implementing strategies that enhance productivity and streamline processes.
Overview
15
15
years of professional experience
Work History
Claims Manager
Wipro Limited BANGALORE
Tampa, Florida
01.2025 - Current
- Managed claims processing for various insurance products and services.
- Conducted audits of performance metrics, ensuring accuracy and compliance.
- Reviewed documentation for compliance with company policies and regulations.
- Coordinated with clients to gather information for claim evaluations.
- Analyzed claims data to identify trends, informing strategies for operational efficiency.
- Collaborated with cross-functional teams to streamline claims workflows and communication.
- Motivated team members, fostering a culture of accountability to meet turnaround time goals.
- Oversaw handling of catastrophic claims, coordinating resources for rapid response.
Senior Claims Manager
Elevance
Tampa, Florida
08.2011 - 02.2024
- Oversaw claims processing, ensuring adherence to company policies and regulatory standards.
- Facilitated team meetings to analyze claim trends and identify operational enhancements.
- Collaborated with cross-functional teams to resolve complex claims issues.
- Trained staff on updated claims procedures and software tools.
- Analyzed claim data to identify areas for process enhancement.
- Reviewed and approved high-value claims for final resolution.
- Guided junior staff in implementing best practices for effective claims handling.
- Managed team members effectively to meet high production standards with accurate results.
- Collaborated with quality team regarding quality assurance reviews.
- Monitored objectives to determine effectiveness of workflows, facilitating training, and mentoring for improvement.
- Provided guidance and support to junior team members on how to handle difficult claims cases.
- Analyzed historical data regarding previous claims activity in order to assess risk levels associated with various types of claims.
- Collaborated with other departments within the organization to ensure a seamless transition from initial filing through resolution of each claim.
- Managed and coordinated the investigation of complex claims to ensure accuracy, efficiency and compliance with applicable laws.
- Organized regular training sessions for staff on new industry trends, best practices and legal requirements.
- Oversaw onboarding processes for new team members, delivering training on claims handling.
- Directed the application of reserves on claims, ensuring accurate financial reporting and compliance with regulatory requirements.
- Led team in investigating, evaluating, and settling insurance claims, ensuring compliance with policy obligations and legal requirements.
- Established strong relationships with external partners, including adjusters, contractors, and medical providers, to streamline claims resolution.
- Oversaw the development and implementation of claims processing systems to improve efficiency and accuracy.
- Managed complex claims negotiations, achieving favorable settlements within policy limits.
- Adapted claims processes and policies in response to legislative changes, technological advancements, and market conditions.
Education
MBA - Business Administration
University of Phoenix
Tempe, AZ07-2015
Skills
- Claims negotiation
- Regulatory compliance
- Insurance policy review
- Risk assessment
- Performance auditing
- Process optimization
- Data management
- Policy interpretation
- Change management
- Planning and organization
- Cross-functional collaboration
- Team leadership and motivation
- Staff training
- Problem solving
- Effective communication
- Adaptability
Timeline
Claims Manager
Wipro Limited BANGALORE
01.2025 - Current
Senior Claims Manager
Elevance
08.2011 - 02.2024
MBA - Business Administration
University of Phoenix