Karen Shumate
West
Summary
Results-driven Claims Analyst specializing in claims processing, compliance, and customer service. Demonstrated expertise in managing high-volume claims efficiently while ensuring accuracy and confidentiality.
Overview
14
14
years of professional experience
Work History
Claims Analyst
Illumifin (formerly Sentinel Security Life Insurance Company)
Minneapolis, MN
01.2015 - 04.2026
- Processed Medicare Supplement Claims.
- Processed Life Insurance Claims.
- Collaborated with other teams to resolve escalated claim issues efficiently.
- Maintained strict confidentiality with all personal data as per HIPPA.
- Managed high-volumes of claims, prioritizing tasks to ensure timely completion of all claims.
- Maintained compliance with industry regulations and company policies while managing sensitive client information and claims records.
- Demonstrated a high level of accuracy and attention to detail in reviewing claim documentation for approval or denial decisions.
- Enhanced customer satisfaction by resolving foreign travel claims and life claims outside the United States in a timely manner.
- Interacted with clients and employees, which helped cultivate positive working relationships.
- Provided exceptional customer service by promptly addressing inquiries from policyholders, agents, and other stakeholders regarding the status of their claims.
- Assisted clients throughout the entire lifecycle of their claim, from initial filing to final settlement or denial determination.
- Followed up on potentially fraudulent claims initiated by claims representatives.
- Mentored junior team members, sharing expertise in claims analysis techniques and fostering professional growth within the department.
Customer Service Representative
Sentinel Security Life Insurance Company
Salt Lake City, UT
12.2011 - 01.2015
- Resolved customer inquiries and concerns through effective communication and problem-solving techniques.
- Managed policy renewals and updates, ensuring compliance with regulatory standards and company policies.
- Trained new staff on company protocols and customer service best practices to promote team efficiency.
- Collaborated with cross-functional teams to address complex issues impacting customer service delivery.
- Managed high-stress situations effectively, maintaining professionalism under pressure while resolving disputes or conflicts.
- Resolved customer complaints with empathy, resulting in increased loyalty and repeat business.
- Responded to customer requests for products, services, and company information.
- Maintained up-to-date knowledge of product and service changes.
Skills
- Claims
- Claims analysis
- Policy interpretation
- Computer skills
- Coaching and mentoring
- Claims processing
- Decision-making
- Records review
- Reliability
- Problem-solving abilities
- Attention to detail
- Time management
Timeline
Claims Analyst
Illumifin (formerly Sentinel Security Life Insurance Company)
01.2015 - 04.2026
Customer Service Representative
Sentinel Security Life Insurance Company
12.2011 - 01.2015