KAREN VAUGHN
Mesa,AZ
Summary
At State Farm Companies, I excelled in claims processing and investigation, enhancing customer satisfaction by efficiently resolving issues and maintaining high accuracy. My strong analytical abilities and empathetic communication fostered positive client relationships, contributing significantly to team goals and streamlining the claims process for improved efficiency.
Overview
14
14
years of professional experience
Work History
Claim Associate
State Farm Companies
03.2020 - 01.2025
- Monitored claim trends to identify potential issues.
- Provided support to senior associates with complex cases.
- Updated claim status in tracking systems as needed.
- Maintained organized files for all claim-related materials.
- Processed documentation related to claims submissions.
- Consistently met or exceeded performance metrics in key areas such as accuracy, timeliness, and customer satisfaction ratings.
- Managed a high volume of claims efficiently by prioritizing tasks in a fast-paced environment.
- Enhanced customer satisfaction by promptly addressing client concerns and resolving disputes professionally.
- Contributed to team goals by collaborating with peers and sharing best practices for improved performance.
- Established rapport with clients through empathetic communication skills while managing sensitive information during claim evaluation processes.
- Demonstrated advanced technical skills in navigating internal systems for efficient record-keeping and data management related to claim files.
- Collaborated with adjusters and underwriters to verify coverage details, ensuring accurate claim settlements.
- Reduced fraudulent claims through thorough investigations and strict adherence to company policies.
- Assisted customers in filing accurate claims, providing clear instructions on requirements and documentation needed for successful submissions.
- Maintained comprehensive knowledge of insurance products and regulations to provide informed guidance during the claims process.
- Leveraged analytical thinking when evaluating policy interpretations in order to accurately assess liability outcomes.
- Expedited claim resolutions by effectively negotiating with clients, legal representatives, and other stakeholders.
- Proactively participated in ongoing professional development to maintain up-to-date knowledge of industry trends, resulting in improved performance and higher levels of client satisfaction.
- Streamlined the claims process for faster resolution, utilizing strong organizational skills and attention to detail.
- Improved claim processing efficiency by meticulously reviewing and analyzing insurance claims.
- Followed up with customers on unresolved issues.
- Responded to customer inquiries, providing detailed explanations of insurance policies and claims processes.
- Utilized excellent analytical and problem-solving skills to quickly and accurately assess insurance claims.
- Complied with regulations and guidelines related to claims processing to maintain quality and adherence to standards.
- Assisted in onboarding of new claims processors to familiarize with company procedures, policies and processes.
- Identified and reported potential fraud or abuse related to claims to protect system's integrity.
- Established positive and trusting relationships with injured clients, administering efficient customer service and processing claims quickly.
- Collaborated with claims department and industry anti-fraud organizations to resolve claims.
- Developed and implemented quality assurance processes to check accuracy of claims processing.
- Verified client information by analyzing existing evidence on file.
- Posted payments to accounts and maintained records.
- Prepared insurance claim forms or related documents and reviewed for completeness.
- Checked documentation for accuracy and validity on updated systems.
- Generated, posted and attached information to claim files.
- Modified, updated and processed existing policies.
Dispatcher
State Farm Companies
04.2013 - 03.2020
- Managed high-stress situations calmly and effectively, ensuring timely assistance to those in need.
- Communicated with drivers and personnel to coordinate timely delivery of goods and materials.
- Directed dispatching, routing, and tracking of [Number] fleet vehicles.
- Collaborated with fellow dispatchers to maintain a seamless workflow during shift changes.
Customer Service Associate
State Farm Companies
05.2011 - 04.2013
- Helped large volume of customers every day with positive attitude and focus on customer satisfaction.
- Handled customer complaints professionally, resulting in satisfactory outcomes and positive feedback.
- Maintained a high level of product knowledge, providing accurate information to customers.
- Answered customer telephone calls promptly to avoid on-hold wait times.
- Actively listened to customers, handled concerns quickly and escalated major issues to supervisor.
- Enhanced customer satisfaction by effectively addressing inquiries and resolving issues.
- Achieved consistently high levels of customer satisfaction by prioritizing empathy, patience, and effective problem-solving skills during interactions.
- Developed strong relationships with clients through attentive listening and empathetic understanding of their needs.
- Managed high call volume with exceptional time management skills, minimizing wait times for customers.
Education
No Degree - Computer Processing
University Hospital Vocational School
Manhasset, NY03-1980
Associate of Arts -
Molloy College
Rockville Centre, NY12-1975
High School Diploma -
Hempstead High School
Hempstead, NY06-1970
Skills
- Claims processing
- Claims investigation
- Policy interpretation
- Claims
Accomplishments
- Used Microsoft Excel to develop inventory tracking spreadsheets.
- Documented and resolved [Issue] which led to [Results].
Timeline
Claim Associate
State Farm Companies
03.2020 - 01.2025
Dispatcher
State Farm Companies
04.2013 - 03.2020
Customer Service Associate
State Farm Companies
05.2011 - 04.2013
No Degree - Computer Processing
University Hospital Vocational School
Associate of Arts -
Molloy College
High School Diploma -
Hempstead High School
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