Jericka Smotherman
Lancaster,TX
Summary
Experienced Claims Processing and Customer Service Professional with over 10 years in insurance claims and benefits administration. Skilled in high-volume claims review, data analysis, and collaboration with internal teams for timely resolutions. Expertise in researching discrepancies, verifying documentation, and maintaining compliance while ensuring quality standards.
Overview
16
16
years of professional experience
Work History
Customer Benefit Advisor
COLONIAL LIFE / UNUM GROUP
09.2022 - 01.2024
- Assist policyholders with supplemental health, accident, and short-term disability claims and benefits.
- Review insurance documents and claims information to verify accuracy and determine claim requirements.
- Research claim inquiries and explain policy benefits, coverage, and claim status.
- Obtain medical documentation and authorization forms required for claims processing.
- Maintain HIPAA compliance while handling confidential medical information.
- Analyze claim documentation and identify missing information requiring follow-up.
- Process high-volume inbound calls averaging 80+ calls daily while maintaining quality standards.
- Consistently maintained performance metrics averaging 98%.
Dispatcher
PROMISED PROVISIONS TRUCKING LLC
09.2021 - 12.2022
- Maintained detailed records, schedules, and operational databases.
- Conducted data entry, tracking, reporting, and documentation management.
- Resolved customer concerns through research and problem-solving.
- Coordinated communications among multiple stakeholders while maintaining accuracy and efficiency.
Customer Experience Agent
VACASA
07.2020 - 09.2021
- Investigated customer concerns and resolved complex service issues.
- Maintained detailed electronic records and documentation.
- Navigated multiple systems simultaneously to research and verify information.
- Escalated complex cases requiring additional review and resolution.
- Collaborated with cross-functional teams to ensure customer satisfaction.
Claims Services Operator
HARTE HANKS
05.2020 - 07.2020
- Processed unemployment claims and reviewed supporting documentation.
- Verified claim information for accuracy and eligibility requirements.
- Utilized claims software to enter data, maintain records, and generate reports.
- Ensured compliance with claims processing guidelines and regulatory standards.
- Conducted claim research and follow-up on unresolved issues.
- Evaluated data quality and accuracy within claims management systems.
- Assisted with quality assurance reviews and process improvement efforts.
- Consistently exceeded performance standards with 95%+ quality metrics.
Loyalty Program Associate
HYATT CORPORATION
03.2018 - 07.2019
- Researched customer accounts and resolved inquiries.
- Maintained customer records and account documentation.
- Exceeded quality and accuracy goals while managing high-volume interactions.
- Assisted customers by explaining program benefits and eligibility requirements.
Administrator
SMOTHERMAN TRANSPORT
05.2015 - 03.2018
- Managed company records, reporting functions, and database maintenance.
- Generated reports and analyzed operational trends.
- Maintained accurate documentation and tracking records.
- Supported business operations through data management and administrative oversight.
Customer Care Advocate
BLUE CROSS BLUE SHIELD OF GEORGIA
08.2009 - 08.2012
- Verified insurance eligibility and benefits information.
- Assisted members with claims inquiries, claim status updates, and coverage questions.
- Researched claim issues and coordinated resolution efforts.
- Educated members regarding health insurance policies and benefits.
- Maintained compliance with healthcare regulations and company policies.
- Documented customer interactions and claim-related activities accurately.
Claims Representative
AFLAC
11.2007 - 07.2008
- Processed and paid insurance claims, ensuring compliance with policy provisions to facilitate timely resolutions.
- Reviewed claim documentation and verified policy eligibility to uphold accuracy and integrity of claims.
- Conducted investigations and gathered supporting information for claim decisions.
- Conducted investigations and gathered supporting information to support informed claim decisions.
- Collaborated with internal departments to ensure timely claims resolution.
- Interviewed policyholders to obtain additional claim information and documentation.
- Maintained detailed claim records and documentation.
Education
High School Diploma -
Central High School
Phenix City, AlabamaSkills
- Customer Claims Support
- Medical and Disability Claims
- Eligibility Verification
- Customer Issue Resolution
- Claims Management Systems
- Claims Tracking Systems
- Claims tracking
- Service Quality Improvement
- HIPAA Compliance
- Medical Terminology
- Trend Analysis & Reporting
- Data Entry & Database Management
- Database Maintenance
- Microsoft Office Suite
- Microsoft Excel
- Microsoft Word
- Outlook
- PowerPoint
- Document Processing
- Client Management Tools
- Customer Database Management
- Slack
Timeline
Customer Benefit Advisor
COLONIAL LIFE / UNUM GROUP
09.2022 - 01.2024
Dispatcher
PROMISED PROVISIONS TRUCKING LLC
09.2021 - 12.2022
Customer Experience Agent
VACASA
07.2020 - 09.2021
Claims Services Operator
HARTE HANKS
05.2020 - 07.2020
Loyalty Program Associate
HYATT CORPORATION
03.2018 - 07.2019
Administrator
SMOTHERMAN TRANSPORT
05.2015 - 03.2018
Customer Care Advocate
BLUE CROSS BLUE SHIELD OF GEORGIA
08.2009 - 08.2012
Claims Representative
AFLAC
11.2007 - 07.2008
High School Diploma -
Central High School