Janika Watts
Detroit,MI
Overview
5
5
years of professional experience
Work History
Sr. Disability Claim Specialist
Sedgwick
Southfield, MI
02.2022 - Current
- Reviewed incoming claims for accuracy and completeness in accordance with policy provisions.
- Investigated, evaluated, and negotiated settlements of assigned claims.
- Responded to inquiries from claimants, attorneys, medical providers. regarding the status of their claim.
- Maintained timely and accurate records of all claim activity.
- Assisted in the development of new processes for handling claims more effectively.
- Participated in special projects as assigned by management team.
- Provided excellent customer service throughout the entire claims process.
- Developed effective relationships with customers through communication via phone or email.
- Ensured that all documentation was accurately entered into the system.
- Reviewed policies and procedures regularly to ensure they are up-to-date with industry standards.
- Processed payments accurately according to established timelines.
- Processed claims for payment or forwarded to appropriate personnel for further investigation
- Examined claims, records and procedures to grant approval of coverage.
ADA Accommodations Coordinator
Sedgwick
Southfield, MI
06.2020 - 02.2024
- Conducted initial employee interview per process guidelines
- Informed claimants of the documentation required to process claims, the required time frames, and claims status either by phone, written correspondence, and/or the claims system.
- Reviewed medical information to determine if the claimant met the requirements under the ADA, state, and/or client requirements for a qualifying condition.
Subrogation Customer Service Representative
Equiqan
Southfield, MI
08.2019 - 05.2020
- Answered customer inquiries and provided accurate information regarding products and services.
- Provided excellent customer service to resolve customer complaints in a timely manner.
- Gathered customer feedback through surveys and used the data to improve customer service.
- Performed administrative tasks such as filing paperwork, updating databases and generating reports.
- Developed strong relationships with customers by providing personalized assistance and support.
- Promoted high customer satisfaction by resolving problems with knowledgeable and friendly service.
- Answered incoming calls and emails, providing frontline customer support or assistance with product and service transactions.
- Answered inbound calls, chats and emails to facilitate customer service.
Education
Bachelor of Science -
Michigan State University
East Lansing, MISkills
- Claims investigation
- Claims analysis
- Data integrity
- Problem-solving
- Premium calculations
- Documentation
- Relationship building
- Documentation processing
- Number-savvy
- Document review
- Denied claims identification
- Eligibility determination
- Adaptability and flexibility
- Attention to detail
- Coverage determination
- Excellent communication
- Patient contact
- Personal data evaluation
- Claims documentation
- Computer proficiency
- Interpersonal skills
- Regulatory compliance adherence
- Data entry
- Forms preparation
- Background in insurance
- Continuous improvement
- Teamwork skills
- Professional demeanor
- Detail orientation
- Investigation support
- Adaptability
- Research skills
- Analytical thinking
- Organizing and prioritizing work
- Team building
- Insurance terminology
- Multitasking
- Decision-making
- Problem-solving abilities
- Verbal and written communication
- Teamwork
Timeline
Sr. Disability Claim Specialist
Sedgwick
02.2022 - Current
ADA Accommodations Coordinator
Sedgwick
06.2020 - 02.2024
Subrogation Customer Service Representative
Equiqan
08.2019 - 05.2020
Bachelor of Science -
Michigan State University