Summary
Overview
Work History
Education
Skills
Timeline
Generic

Heather Neff

Springfield,IL

Summary

Friendly insurance professional experienced in investigating and processing insurance claims. Hardworking and communicative individual excels at interpreting policies and negotiating payment solutions. Recognized for providing optimum service to policyholders and quickly identifying fraudulent claims. Organized and dependable candidate successful at managing multiple priorities with a positive attitude. Willingness to take on added responsibilities to meet team goals. Detail-oriented team player with strong organizational skills. Ability to handle multiple projects simultaneously with a high degree of accuracy.

Overview

16
16
years of professional experience

Work History

Claims Specialist

State Farm
11.2022 - Current
  • Enhanced customer satisfaction with timely communication, empathy, and clear explanations of claim outcomes.
  • Managed a high volume of claims effectively by prioritizing tasks and maintaining excellent organizational skills.
  • Developed strong working relationships with external partners such as adjusters, legal counsel, and medical professionals to facilitate efficient claim resolution processes.
  • Responded to inquiries by answering questions, providing information and directing customers to appropriate resources.
  • Maintained compliance with industry regulations and standards by staying current on relevant laws, policies, and best practices for handling insurance claims.
  • Enhanced customer satisfaction by efficiently managing insurance claims processes and providing timely resolutions.
  • Evaluated and settled complex insurance claims in strict timeframes.
  • Followed up with customers on unresolved issues.
  • Upheld a high level of accuracy by consistently double-checking figures, data entries, calculations, before finalizing any settlement documents or payments.
  • Boosted company reputation by delivering exceptional customer service during claim investigations and settlements.

Telecommunications

Springfield Clinic
08.2012 - 11.2022

My position is the first point of contact with the patient. I greet each caller with friendliness and professionalism. As a PAS I take in- coming calls from patients, doctors and hospitals. Depending on the caller I access multiple computer applications to meet the callers needs. Sometimes transferring a call, or paging doctors for hospital departments. At this time I am familiar with Word, Skype, Outlook and have looked into OneNote. I am a shift lead. Responsibilities for a shift lead require problem solving team questions, making and adhering to schedules and addressing any phone issues that arise.

Patient Advocate

Blue Cross And Blue Shield
06.2008 - 10.2011

As a PA I took in-coming calls from customers, doctor offices, and other insurance companies. By utilizing many computer applications I was able to quote detailed benefits for many different corporations. I was able to explain to customers their EOB's. If they had an issue with their bill I could help them determine if an appeal could be made. Many times I contacted providers offices to request a new claim with corrected procedure or diagnosis codes. Our training included handling a call from start to finish. One aspect of our training was handling an escalated call. I loved learning how to "read" the customers personality to better handle the call. The calls were timed and recorded. I was able to get information from the caller, pull up applications to get the answers they needed all while documenting the call in detail. I really enjoyed helping people navigate and understand their policy benefits.

Education

No Degree - Elementary Education

I.S.U.
05.1989

Skills

  • Claims
  • Claims Processing
  • Claims Investigation
  • Verbal Communication
  • Decision-Making
  • Critical Thinking
  • Customer Service
  • Organizing and Prioritizing Work
  • Attention to Detail
  • Teamwork and Collaboration
  • Insurance Coverage Verification
  • Claims adjustment
  • Documentation skills
  • Active Listening
  • Information Verification

Timeline

Claims Specialist

State Farm
11.2022 - Current

Telecommunications

Springfield Clinic
08.2012 - 11.2022

Patient Advocate

Blue Cross And Blue Shield
06.2008 - 10.2011

No Degree - Elementary Education

I.S.U.
Heather Neff