Dalecia Kimbrough
Columbus, GA
Summary
Professional with comprehensive experience in claims processing and evaluation. Demonstrates strong analytical skills, thorough knowledge of insurance policies, and consistent track record of identifying and resolving complex claims. Valued team player with strong focus on collaboration and results, adaptable to evolving work environments. Known for reliability, problem-solving abilities, and effective communication.
Overview
22
22
years of professional experience
Work History
Claims Examiner
Aflac
07.2021 - Current
- Handled sensitive information with discretion, ensuring confidentiality of personal and financial details for claimants throughout the claims examination process.
- Utilized analytical skills to evaluate medical bills for accuracy and appropriateness of charges before approving payments as part of the claims process.
- Participated in cross-functional team meetings to address organizational challenges related to claims management and develop solutions collaboratively.
- Reduced claim processing time by implementing efficient workflow strategies and prioritizing tasks effectively.
Customer Care Advocate
Aflac
12.2018 - 07.2021
- Managed multiple priorities under tight deadlines while remaining calm under pressure and delivering excellent results consistently.
- Educated customers on product features, benefits, and usage, resulting in higher user satisfaction.
- Participated in ongoing training opportunities to expand skillset and stay current on best practices for delivering superior support.
- Kept up-to-date with industry trends, product updates, and policy changes to provide knowledgeable assistance at all times.
- Mentored new hires by sharing knowledge and providing guidance, contributing to a more competent and cohesive team overall.
Fraud Analyst
TSYS
09.2017 - 04.2019
- Evaluated customer data to identify and prevent fraudulent activities.
- Analyzed large amounts of data to find patterns of fraud and anomalies.
- Performed risk assessments to determine level of fraud risk and prioritize investigations.
- Increased accuracy in identifying fraudulent transactions by utilizing advanced data analytics techniques and software tools.
- Consistently exceeded performance targets by demonstrating keen attention to detail and exceptional analytical skills in identifying fraudulent patterns.
Office Coordinator
Pro Companies
12.2015 - 01.2018
- Provided administrative support to staff members, assisting with daily tasks as needed to promote productivity across the organization.
- Tracked records, filed documents, and maintained communication between clients to manage office activities.
- Served as a point of contact for clients visiting the office, providing exceptional customer service that led to increased client retention rates.
- Maintained strict confidentiality of sensitive information, upholding the highest level of professionalism at all times.
- Increased efficiency by regularly evaluating office workflows and recommending improvements as necessary.
Project Coach
Afni
09.2016 - 11.2017
- Strengthened relationships with key stakeholders by maintaining open lines of communication, regularly soliciting feedback, and delivering on commitments made during negotiations.
- Developed customized coaching plans for individual team members based on their unique strengths, weaknesses, and growth opportunities.
- Improved project outcomes by implementing effective coaching strategies and fostering a collaborative team environment.
- Mitigated risks to project success by proactively identifying potential issues and developing contingency plans as needed.
Operations Expert
Anthem
03.2003 - 10.2015
- Promoted a positive work environment through open communication channels, fostering team collaboration and high morale.
- Collaborated with other departments to address recurring customer concerns, improving overall service quality.
- Improved customer satisfaction by addressing and resolving escalated issues promptly and professionally.
- Managed escalations effectively, resolving complex issues quickly while maintaining high levels of professionalism and empathy towards customers.
- Provided ongoing feedback to team members, leading to improved communication skills and conflict resolution abilities.
Education
Bachelor of Science - Business Administration And Management
University of Phoenix
Columbus, GA05.2012
Skills
- Reviewing and evaluating documentation
- Effective written and verbal communication
- Problem-Solving
- Time Management
- Knowledge of Insurance Policies
- Attention to detail
- Critical Thinking
- Adaptability
- Report Writing and Data Analysis
- Empathy and Interpersonal
Timeline
Claims Examiner
Aflac
07.2021 - Current
Customer Care Advocate
Aflac
12.2018 - 07.2021
Fraud Analyst
TSYS
09.2017 - 04.2019
Project Coach
Afni
09.2016 - 11.2017
Office Coordinator
Pro Companies
12.2015 - 01.2018
Operations Expert
Anthem
03.2003 - 10.2015
Bachelor of Science - Business Administration And Management
University of Phoenix
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