Ethel Swindell-Williams
Whiteville,NC
Summary
Experienced claims representative dedicated to delivering exceptional customer service and adhering to company policies. Skilled in investigating claims, verifying information, and effectively managing settlements. Friendly and upbeat team player with a disciplined and organized approach. Bringing over 6 years of valuable claims experience to contribute to the success of the organization.
Overview
10
10
years of professional experience
Work History
Claims Representative
Conduent
07.2019 - 05.2024
- Enhanced client satisfaction by efficiently processing claims within designated time frames.
- Coordinated with healthcare providers to verify treatment plans and expenses.
- Delivered personalized customer service, addressing policyholder concerns and clarifying coverage details.
- Maintained up-to-date knowledge of regulatory changes, ensuring company compliance and minimizing legal risks.
- Minimized financial losses by identifying fraudulent claims through thorough analysis and investigation.
- Trained new Claims Representatives on company policies, procedures, and software systems, improving overall team productivity.
Claims Representative
Everise
01.2017 - 06.2019
- Followed up with customers on unresolved issues.
- Provided exceptional customer service, addressing concerns and resolving issues promptly.
- Developed in-depth understanding of insurance policies and procedures.
- Worked productively in fast-moving work environment to process large volumes of claims.
- Collaborated with internal departments and external vendors to resolve claims.
- Conducted detailed investigations into suspicious claims, reducing instances of fraud.
Claims Representative
Alorica
08.2014 - 01.2017
- File and process client insurance claims
- Ensure the coverage and figure the payment amount for each claim
- Draft and send statements of amount of coverage and amount owed to the customer
- Send payments to doctors' offices or hospitals for covered procedures
- Assist new customers in signing up for insurance coverage
- Enter all customer information into the computer system for future record
- Reimburse customers for payments made that should have been covered
- Help with customer appeals to denied claims.
Education
High School Diploma -
East Bladen High School
Elizabethtown, NC06-2013
Skills
- In-depth knowledge of medical insurance and medical terminology
- Experience in personal auto home and medical insurance
- Great ability to gather information and input data into computer system
- Capable of typing 40 words per minute
- Exceptional communication skills with customers and coworkers
- Organized and efficient in all work
- Claims Investigation
- Time Management
- Policy understanding
Timeline
Claims Representative
Conduent
07.2019 - 05.2024
Claims Representative
Everise
01.2017 - 06.2019
Claims Representative
Alorica
08.2014 - 01.2017
High School Diploma -
East Bladen High School
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