Jylane Freeman
Milledgeville,GA
Summary
- Excellent communication skills, both verbal and written
- Strong problem-solving abilities
- Proficient in CRM software and ticketing systems
- Ability to multitask and prioritize in a fast-paced environment
Overview
7
7
years of professional experience
Work History
Claims Specialists
Asurion
02.2023 - 04.2024
- 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.
- Responded to inquiries by answering questions, providing information and directing customers to appropriate resources.
- Followed up with customers on unresolved issues.
- Collaborated with cross-functional teams to optimize claims handling procedures, resulting in improved productivity.
IT Specialist
Wolters Kluwer Tax & Accounting
10.2022 - 02.2023
- Configured hardware, devices, and software to set up work stations for employees.
- Managed hardware and software inventory, ensuring timely updates and replacements as needed.
- Maintained servers and systems to keep networks fully operational during peak periods.
- Provided exceptional customer service by promptly addressing problems reported by endusers.
- Walked individuals through basic troubleshooting tasks.
- Suggested software and hardware modifications to reduce lag time and improve overall speed.
Claims Specialist
State Farm
12.2020 - 10.2022
- Managed a high volume of claims effectively by prioritizing tasks and maintaining excellent organizational skills.
- Enhanced customer satisfaction with timely communication, empathy, and clear explanations of claim outcomes.
- 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.
- Handled high-pressure situations with professionalism and composure, consistently achieving positive outcomes for both clients and the organization.
- Settled complex claims fairly by applying critical thinking, negotiation skills, and detailed knowledge of insurance policies.
- Followed up with customers on unresolved issues.
- Conducted full claim investigations and reported updates and legal actions.
- Understood requirements for disputes, gathered evidence to support claims and prepared customer cases to handle appeals.
- Provided exceptional customer service during stressful situations by offering empathy and support while resolving issues efficiently.
- Performed administrative duties by verifying documentation, researching facts and contacting other parties involved to determine fault percentages and minimize potential losses.
- Improved claim processing efficiency by streamlining workflows and implementing time-saving strategies.
- Reviewed new files to determine current status of injury claim and to develop plan of action.
- Provided advice to customers regarding claims, rights and insurance processes to prevent disputes.
- Escalated files with significant indemnity exposure to supervisor for further investigation.
- Conducted risk evaluations on claims settlement proposals to encourage sound decision-making regarding settlement offers.
Medical Claims Specialist
GEICO
10.2018 - 11.2020
- Reduced errors in claims submissions through meticulous attention to detail and thorough review processes.
- Improved claim processing efficiency by streamlining workflows and implementing best practices.
- Submitted electronic/paper claims documentation for timely filing.
- Effectively resolved claim disputes by conducting thorough investigations and presenting findings to stakeholders clearly and concisely.
- Researched and resolved complex medical claims issues to support timely processing.
- Verified patient insurance coverage and benefits for medical claims.
- Assessed medical claims for compliance with regulations and corrected discrepancies.
- Responded to correspondence from insurance companies.
- Processed insurance payments and maintained accurate documentation of payments.
- Made contact with insurance carriers to discuss policies and individual patient benefits.
Customer Service Representative
GEICO
04.2017 - 10.2018
- Handled customer inquiries and suggestions courteously and professionally.
- Managed high-stress situations effectively, maintaining professionalism under pressure while resolving disputes or conflicts.
- Actively listened to customers, handled concerns quickly and escalated major issues to supervisor.
- Resolved customer complaints with empathy, resulting in increased loyalty and repeat business.
- Offered advice and assistance to customers, paying attention to special needs or wants.
- Handled escalated calls efficiently, finding satisfactory resolutions for both customers and the company alike.
- Maintained customer satisfaction with forward-thinking strategies focused on addressing customer needs and resolving concerns.
- Developed strong product knowledge to provide informed recommendations based on individual customer needs.
- Enhanced customer satisfaction by promptly addressing concerns and providing accurate information.
- Processed customer service orders promptly to increase customer satisfaction.
- Participated in team meetings and training sessions to stay informed about product updates and changes.
- Provided primary customer support to internal and external customers.
- Exceeded performance metrics consistently, earning recognition as a top performer within the team.
- Tracked customer service cases and updated service software with customer information.
- Streamlined call center processes for improved efficiency and reduced wait times.
- Participated in cross-functional initiatives aimed at enhancing overall business operations and customer satisfaction levels.
- Analyzed customer service trends to discover areas of opportunity and provide feedback to management.
- Improved communication between departments by facilitating interdepartmental meetings focused on problem-solving strategies for common issues affecting customers'' experiences.
Education
Georgia State University
Atlanta, GABaldwin High School
Milledgeville, GA2013
Skills
- Excellent communication skills, both verbal and written
- Strong problem-solving abilities
- Proficient in CRM software and ticketing systems
- Ability to multitask and prioritize in a fast-paced environment
- Exceptional interpersonal skills and customer-centric mindset
- Medical Terminology: Knowledge of medical terminology and procedures to accurately process medical claims
- Insurance Billing: Proficiency in insurance billing processes, including coding, submission, and follow-up on claims
- Claim Processing: Experience in reviewing and processing medical claims efficiently and accurately
- Coding: Familiarity with medical coding systems such as ICD-10, CPT, and HCPCS to ensure proper coding of diagnoses and procedures
- Reimbursement Knowledge: Understanding of insurance reimbursement policies and procedures to maximize claim reimbursement
- Compliance: Adherence to HIPAA regulations and other healthcare compliance standards to protect patient confidentiality and ensure regulatory compliance
- Communication: Strong communication skills to interact with healthcare providers, insurance companies, and patients regarding claim status and resolution
- Problem-Solving: Ability to analyze claim discrepancies and resolve issues to ensure timely claim adjudication
- Attention to Detail: Keen attention to detail to accurately review and process claims, ensuring accuracy and completeness of information
- Customer Service: Excellent customer service skills to assist patients and healthcare providers with claim inquiries and resolve issues in a professional and empathetic manner
Timeline
Claims Specialists
Asurion
02.2023 - 04.2024
IT Specialist
Wolters Kluwer Tax & Accounting
10.2022 - 02.2023
Claims Specialist
State Farm
12.2020 - 10.2022
Medical Claims Specialist
GEICO
10.2018 - 11.2020
Customer Service Representative
GEICO
04.2017 - 10.2018
Georgia State University
Baldwin High School