Deja Randle
Houston,TX
Summary
Results-driven professional with diverse experience in Claims Adjusting, Human Resources, Customer Service, and Executive Support. Skilled in claims evaluation, employee relations, and executive coordination. Capable of adapting to organizational needs and delivering impactful results in fast-paced settings. Seeking a role that leverages a versatile skill set and strong communication to drive success.
Overview
14
14
years of professional experience
Work History
Claims Adjuster Specialist
Progressive Insurance
Houston, TX
04.2023 - Current
- Examine, interpret, adjust and approve claims for payment based on contract language, terms and limitations, all while following published polices and guidelines
- Analyze and interpret medical reports, follow-up with no fault parties, and manage claims process to ensure efficient resolution
- Negotiated settlements with claimants and their attorneys to facilitate claim resolutions
- Estimated treatment costs and compensation for accident victims to ensure fair settlements
- Interview, collect and document information from various parties such as claimants, agents/brokers, attorneys, and police.
- Collaborated with legal department to prepare and strategize cases for litigation
- Skills: Claims Analysis Evaluation, Risk Assessment Liability Determination, Policy Interpretation Coverage Review, Negotiation Settlement of Claims, Fraud Detection & Prevention, Claims Documentation Reporting, Customer Service Communication, Compliance Regulatory Knowledge, Loss Adjustment, Cost Control, and Conflict Resolution
Customer Service Advocate
HealthPartners
Bloomington, MN
04.2022 - 04.2023
- Provided empathetic, high-quality support to diverse member populations regarding complex, sensitive, and urgent medical insurance questions, consistently exceeding monthly member satisfaction scores.
- Achieved a 95%+ first call resolution (FCR) rate by efficiently navigating multiple, complex internal systems to provide immediate, accurate answers regarding benefits and coverage.
- Navigated complex health insurance policies, including Marketplace plans and Medicare, to accurately define covered vs. non-covered services, reducing member, provider, and pharmacy escalations.
- Educated members on Health Savings Account (HSA) features, contribution limits, and usage, enhancing member understanding and ensuring compliance with IRS regulations.
- Ensured HIPAA compliance with 100% accuracy while documenting member interactions, claims, and inquiries in CRM, safeguarding member information.
- Responded to customer inquiries via phone, email, and chat to provide support.
- Examined customer concerns to determine root causes and deliver satisfactory resolutions.
- Trained new employees on customer service best practices and system tools.
- Resolved escalated calls from front-line associates, addressing complex issues to restore customer satisfaction and maintain trust.
Human Resources Specialist
Wells Fargo Home Mortgage
Minneapolis, MN
06.2017 - 04.2022
- Resolved 265 employee and partner issues via customer-centric approach, resulting in 97% satisfaction score on complaints
- Ensured company compliance with federal and state regulations.
- Responded to unemployment requests, FMLA, and LOA inquiries, and initiated exit interview process to support employee transitions.
- Ensured data accuracy and compliance in Human Resources Information System (HRIS).
- Managed H-1b process and maintained business relationship with third-party vendors
- Delivered monthly analysis of separations, benefits, and sick leave to inform broader team and management decisions.
- Implemented HR policies and procedures to promote a positive workplace environment.
- Analyzed employee feedback to improve engagement and retention strategies.
- Assisted in the development of training materials for employee skill enhancement.
- Assisted candidates with application processes by answering questions about application, performing background checks, providing I-9 forms and handling drug screening paperwork.
Executive Assistant to the Chief Executive Officer
Seek Careers and Staffing
Eagan, MN
01.2012 - 06.2017
- Took ownership of executives' calendars, scheduling complex meetings, managing conflicts, and prioritizing appointments, preparing detailed meeting agendas, taking minutes, following up on action items, and anticipating/planning for future scheduling needs
- Handled advanced administrative duties including key records maintenance, data compilation for reports, expense report preparation, and editing executive presentations to support executive operations.
- Performed advanced tactical and strategic administrative support tasks for upper executive-level employees of the organization.
- Acted as a gatekeeper, screening and prioritizing phone calls and emails. Responded to routine inquiries and drafts responses on behalf of executives
- Acted as liaison between executives and stakeholders, facilitating communication flow and ensuring alignment on priorities.
- Generated statistical and analytic reports for strategic planning, preparing presentations with insights for executive decision-making.
- Led strategic workforce planning initiatives to align talent with business needs.
Education
High School Diploma -
Eastview High School
Apple Valley, MNS.E.S School Of Environmental Studies -
S.E.S School Of Environmental Studies
Apple Valley, MNSkills
- Claims Analysis Evaluation
- Claims processing
- Negotiation Settlement of Claims
- Settlement negotiation
- Loss Adjustment
- Risk Assessment Liability Determination
- Policy Interpretation Coverage Review
- Fraud Detection & Prevention
- Claims documentation
- Compliance Regulatory Knowledge
- Cost Control
- Workflow management
- Data Analysis
- Customer Service Communication
- Customer service
- Conflict Resolution
- Problem solving
- Critical thinking
- Performance management
- Training evaluation
- Training coordination
- Skill development
- Training effectiveness reporting
- Employee engagement
- HRIS management
- Labor law compliance
- Benefits administration
- Document preparation
- Vendor Management
- Partnerships
- Cross-departmental training
- Project support
- Budget management
- Content scheduling
- Calendar management
- Agenda preparation
- Document preparation
- Executive communication
- Time management
- Travel Coordination
- Performance metrics
- Conflict resolution
- Critical thinking
- Customer service
Community
Black National Society (BNS)
Timeline
Claims Adjuster Specialist
Progressive Insurance
04.2023 - Current
Customer Service Advocate
HealthPartners
04.2022 - 04.2023
Human Resources Specialist
Wells Fargo Home Mortgage
06.2017 - 04.2022
Executive Assistant to the Chief Executive Officer
Seek Careers and Staffing
01.2012 - 06.2017
High School Diploma -
Eastview High School
S.E.S School Of Environmental Studies -
S.E.S School Of Environmental Studies