Franchele Sims
Lithonia,GA
Summary
Analytical Claims Specialist with proven experience investigating and resolving property, health and business claims. Delivers professional and balanced customer service and meets needs of insured, claimant and internal and external customers. Insurance expert with exceptional knowledge of legal liabilities and claims practices and superior interpersonal skills. Tactful Claims Specialist with expertise in settlement preparation, claims processing and appeal filing. Diplomatic and personable professional accustomed to handling sensitive, confidential information and investigating complex liability claims. Committed to maintaining customer satisfaction and contributing to company success.
Overview
9
9
years of professional experience
1
1
Certification
Work History
Claims Specialist
State Farm
Dunwoody, GA
06.2022 - Current
- Researched and reviewed information to determine validity of insurance claims and contacted companies and customers about decisions.
- Conducted interviews with involved claims parties and witnesses to gather detailed information and arrange investigations.
- Resolved claims by approving or denying documentation, calculating benefits due and determining compensation settlement.
- Documented specific claims by completing and recording forms, reports and logs.
- Maintained knowledge of policies and procedures and insurance coverage benefit levels, eligibility systems and verification processes.
- Provided quality customer service to assigned, insured and claimants throughout claims process to deliver timely service to customers.
- Conducted quality control reviews on complaint data and addressed results with colleagues to influence positive change.
- Reduced recurring issues by proactively identifying trends in customer complaints and working with relevant teams to address them.
- Reviewed current policies regularly to ensure alignment with evolving regulatory requirements in the field of consumer complaint management.
- Maintained up-to-date knowledge of industry regulations and compliance requirements related to consumer complaints handling processes.
- Improved overall customer experience by actively listening to concerns and empathizing with complainants while seeking mutually beneficial solutions.
Credit and Account Services Rep 2 Back Office
Comcast
Smyrna, GA
08.2019 - 05.2022
- Developed debt collection protocols applicable to delinquent accounts, defining timelines for courtesy calls and referral of problem accounts to debt collectors.
- Contacted customers to notify of delinquent payments and resolve.
- Kept detailed reports of client and account data, consistently updating database with latest information.
- Verified current and historical residences, property ownership and various types of debt by accessing public records and directories.
- Inbound chats with Internal Employees regarding fraudulent applications,
- Determined credit approval based on financial standing, credit records and payment history.
- Reduced overdue accounts by proactively contacting debtors and negotiating payment arrangements.
- Negotiated settlements with debtors while maintaining professionalism and adherence to company policies.
- Maintained a high level of customer satisfaction through respectful interactions during challenging situations.
- Educated customers about repayment options and financial management techniques, empowering them to take control of their debts.
- Built rapport with clients through empathetic communication, leading to increased success in payment negotiations.
- Developed strong relationships with clients'' representatives which aided in resolving disputes efficiently.
Loan Processing Clerk
Lithonia Finance
Lithonia, GA
08.2016 - 08.2019
- Reviewed and verified borrowers' income, credit reports and property appraisals to prepare documents for underwriting.
- Communicated with customers in person and via telephone to answer questions, process transactions and resolve issues.
- Calculated income, assets and liabilities to meet lender requirements.
- Aggressive Recovery of 30/60/90+ past due accounts
- Process payments over the phone and in person
Bank Teller
Guaranty Bank
Tucker, GA
06.2015 - 07.2016
- Cashed customer checks, verified identification and checked account balances in accordance with bank policy.
- Reconciled cash and checks against computer records at end of shift.
- Entered transactions into computer and issued customer receipts.
- Met or exceeded sales goals by promoting bank products and services in customer interactions.
- Demonstrated expertise in identifying and mitigating potential fraud and transaction risks.
- Welcomed customers and offered pleasant service during entire transaction.
- Opened new checking, savings and lines of credit for customer accounts.
Education
High School Diploma -
Miller Grove High School
Lithonia, GA05.2007
Skills
- Coverage Assessments
- Documentation Review
- Settlement Determinations
- Accident Investigations
- Problem-Solving
- Teamwork and Collaboration
- Customer Service
- Data Entry
- Coverage Determination
- Collections Proficiency
- Attention to Detail
- Income Evaluation
- LexisNexis Software
- Application Review
- Patience and Tolerance
- Complaint Analysis
- Policy Knowledge
- Calm and Professional Under Pressure
- Calm Under Pressure
- Problem Resolution
Certification
- Licenced Claims Specialist, State Farm - 2022
Timeline
Claims Specialist
State Farm
06.2022 - Current
Credit and Account Services Rep 2 Back Office
Comcast
08.2019 - 05.2022
Loan Processing Clerk
Lithonia Finance
08.2016 - 08.2019
Bank Teller
Guaranty Bank
06.2015 - 07.2016
High School Diploma -
Miller Grove High School