Felisha Gurley

Analyzed claims data to identify trends and discrepancies in processing accuracy

• Collaborated with cross-functional teams to resolve complex claim issues efficiently
• Reviewed policy documentation to ensure compliance with regulatory standards and guidelines
• Developed comprehensive reports detailing claim resolutions and status updates for stakeholders
• Utilized advanced analytical tools to assess risk factors associated with claims submissions
• Monitored ongoing changes in healthcare regulations impacting claims processing procedures
• Maintained strict confidentiality with all personal data as per company guidelines.
• Maintained compliance with industry regulations and company policies while managing sensitive client information and claims records.
• Demonstrated a high level of accuracy and attention to detail in reviewing claim documentation for approval or denial decisions.
• Enhanced customer satisfaction by resolving complex claims issues in a timely manner.
• Interacted with clients and employees, which helped cultivate positive working relationships.
• Maintained strong working relationships with third-party vendors, such as independent adjusters and appraisers, to facilitate prompt resolution of claims.
• Provided exceptional customer service by promptly addressing inquiries from policyholders, agents, and other stakeholders regarding the status of their claims.
• Streamlined workflow processes for improved efficiency and reduced claim resolution times.
• Researched claims and incident information to deliver solutions and resolve problems.
• Delivered exceptional customer service to policyholders by communicating important information and patiently listening to issues.
• Followed up with insured individuals regarding premium and deductibles payments.
• Managed high-volume caseloads, prioritizing tasks to ensure timely completion of all claims.
• Assisted clients throughout the entire lifecycle of their claim, from initial filing to final settlement or denial determination.
• Examined claims forms and other records to determine insurance coverage.
• Conducted day-to-day administrative tasks to maintain information files and process paperwork.
• Identified insurance coverage limitations with thorough examinations of claims documentation and related records.
• Reviewed questionable claims by conducting agent and claimant interviews to correct omissions and errors
• Directed claims negotiations within allowable limit of $100, 000 and supported successful litigations for advanced issues.

Resolved technical issues via phone, email, and chat support for diverse user base.

• Diagnosed hardware and software problems using remote desktop tools and troubleshooting techniques.
• Documented and tracked incidents in ticketing system to ensure timely resolution and follow-up.
• Collaborated with IT team to escalate complex issues, ensuring efficient problem resolution for users.
• Maintained knowledge base by updating articles based on recurring issues identified during support sessions.
• Improved customer satisfaction through effective communication and by delivering prompt solutions to inquiries.
• Provided training to new team members on helpdesk procedures and customer service best practices.
• Provided after-hours support when needed, demonstrating commitment to customer satisfaction.
• Developed comprehensive knowledge of company products, enabling accurate support for client needs.
• Collaborated with IT departments to escalate unresolved cases, ensuring prompt resolution for clients.
• Streamlined processes for faster ticket resolution, implementing best practices across the department.
• Improved customer satisfaction by efficiently troubleshooting and resolving technical issues.
• Enhanced team productivity by providing timely assistance to colleagues with technical inquiries.
• Resolved network connectivity issues, restoring full functionality for affected users promptly.
• Contributed to team success by sharing expertise and assisting in training new helpdesk agents.
• Maintained detailed documentation of helpdesk interactions, enabling efficient issue tracking and resolution.
• Exceeded response time targets by quickly addressing incoming helpdesk tickets and phone calls.
• Assisted in hardware and software installations, ensuring smooth transitions for users during upgrades or migrations.
• Managed user accounts, granting necessary permissions while maintaining strict security protocols.
• Provided customer support and technical support to 35-40 customers daily.

• Analyzed system performance to identify areas for optimization and improvement.
• Developed technical documentation to enhance team knowledge and streamline processes.
• Collaborated with cross-functional teams to implement software solutions that improve operational efficiency.
• Led data migration projects, ensuring accuracy and integrity of information transferred between systems.
• Streamlined reporting processes, reducing turnaround time for key performance indicators by automating data retrieval methods.
• Conducted user training sessions on new technologies, enhancing user adoption and satisfaction levels.
• Promptly resolved technical issues for staff to minimize downtime.
• Evaluated vendor offerings for hardware and software purchases, ensuring optimal compatibility with existing infrastructure while maximizing ROI on technology investments.
• Assessed department activities, determining ways to enhance operations performance.
• Researched emerging technologies to add value to current offerings.
• Identified system issues and recommended changes to close system holes.
• Managed IT infrastructure upgrades, ensuring minimal impact on daily operations while enhancing overall system capabilities.
• Served as a subject matter expert on key technology initiatives, providing guidance to stakeholders throughout project lifecycles.
• Analyzed complex data sets to identify trends and improve operational efficiencies.