Successful at developing and deepening customer relations and working well with everyone involved in investigating and adjudicating claims. In-depth understanding of procedures and compliance.
Overview
23
23
years of professional experience
20
20
years of post-secondary education
Work History
Senior Claims Representative (SWAT team)
Anthem, Inc.
1 2024
Promoted January of 2024 to a specialized team that moves to different contracts that are in need of help
A high functioning employee that demonstrates the ability to quickly learn new contracts, policies, and systems
A proven capability to provide top notch quality while maintaining a high performance level.
Senior Claims Representative
Anthem, Inc.
01.2013 - 01.2024
A passionate, goal-oriented, and a highly accomplished claims professional
Thrived while concurrently handling multiple groups' policies and their claims
A proven track record in claims investigations, patient and provider liability determinations, and effectively and efficiently processing claims
Achieved goals and policies for the Department to easily read the new benefits for our client's medical policies and how to apply them to claims
Learned how to help lead teams even when not being a direct leader, which requires a lot of influence and tenacity
Directs the new employees training to help ensure they get the one on one attention needed for questions and any help they might need to better understand systems, benefits and processes
Helped lead team meetings and breakout sessions to go over any and all system issues and cover all updates to our client's medical policy.
Claims Representative II - III
Anthem, Inc.
01.2001 - 01.2013
Began career in Customer Service to help learn products, company culture and about the customer experience
Listening attentively to the caller needs to ensure a positive customer experience
Excelled within a service oriented company and strove for quick resolution of any customer complaints
Progressed to Claims Representative after success in Customer Service role
During this long tenure with Anthem, was promoted from level one to a level three representative
Each level provided more responsibilities, including leading meetings and training new employees
Updated the team when new contracts and policies were available
Created web design, excel spreadsheets, and power points for daily team meetings.
Education
Bachelor of Science - Computer And Information Systems Security
Columbus State University
Columbus, GA
05.2001 - 05.2021
Skills
Java
References
Available upon request
Timeline
Senior Claims Representative
Anthem, Inc.
01.2013 - 01.2024
Bachelor of Science - Computer And Information Systems Security