Summary
Overview
Work History
Education
Skills
Certification
Accomplishments
Timeline
Generic

Karisha McClinton

Cibolo,Texas

Summary

Results-oriented professional with a strong background in banking, insurance claims, and fraud investigations. Over five years of experience in quality assurance and customer service, specializing in leading teams within the fraud and insurance claims sectors. Proficient in claims resolution, risk management, and compliance, driving successful outcomes through problem-solving, communication, and collaboration.

Overview

2024
2024
years of professional experience
1
1
Certification

Work History

Fulfillment Account Specialist II

JP Morgan Chase
San Antonio, Texas
03.2019 - 10.2023
  • Maintain a basic knowledge of all Chase Bank products, services, procedures, policies and appropriate regulatory issues relating to daily job functions including but not limited to: Bank Secrecy Act; Privacy; Fair Lending; Regulation E; deposit, transaction and loan accounts
  • Process account documents making sure the documents are complete and in compliance with bank procedures
  • Risk management and review of all deposit transaction account activity including large item review, kiting, and uncollected funds activity, posting accuracy, image archive and retrieval, and document management activities
  • Item Processing, New Account Document Management, Due to & Due from Adjustments, Check 21 Processing, Image Archive Processing, and Customer Service
  • Identify, research, and resolve transaction and general ledger outages
  • Scanning of loan and/or deposit documents and correspondence pertaining to customer files
  • Maintain the integrity of the core system and input system changes when requested
  • Process account documents making sure the documents are complete and in compliance with bank procedures

Dental Consultant

UnitedHealth Group
San Antonio, Texas
09.2017 - 09.2018
  • Respond to and resolve, on the first call, customer service inquires and issues by identifying the topic and type of assistance the caller needs such as benefits, eligibility and claims, financial spending accounts and correspondence
  • Help guide and educate customers about the fundamentals and benefits of consumer-driven health care topics to select the best benefit plan options, maximize the value of their health plan benefits and choose a quality care provider
  • Contact care providers (dental offices) on behalf of the customer to assist with appointment scheduling or connections with internal specialists for assistance
  • Assist customers in navigating myuhc.com and other UnitedHealth Group websites and encourage and reassure them to become self-sufficient

Onsite Management Dispatcher

Hewlett Packard Enterprise/conduit global
San Antonio, Texas
12.2016 - 09.2017
  • Assists
  • With troubleshooting by evaluating installation needs, ensuring the timely receipt of appropriate parts to minimize downtime and improve installation efficiency
  • Supports
  • Employees with escalated cases, providing expert guidance to resolve complex issues, resulting in a 30% reduction in case escalation rates
  • Probe and isolate issue causes
  • Utilize available resources to identify appropriate solutions for customers
  • Explain product features and benefits, answering questions and setting proper expectations for customer inquiries
  • Ensure customer satisfaction through effective call resolution
  • Identify and escalate emerging product or customer dissatisfaction issues

Loan Processor

Aerotek-F4F
San Antonio, Texas
12.2014 - 10.2016
  • Placed outbound calls to customers explaining the details of the loan application and related documents
  • Skilled in receiving, analyzing, and emulating incoming documents ascertain loan eligibility
  • Verify the accuracy and thoroughness of completed loan application and related documents
  • Explain the different loan repayment modes and assist with selecting the best strategy coinciding with their financial statues
  • Provided an estimate and assess the financial statues of the applicant

Claims Adjuster

USAA
San Antonio, Texas
10.2023
  • Investigate liability and apply appropriate coverage, evaluates, negotiates, and settles moderately complex auto claims such as comprehensive, collision (i.e., multi-vehicle claims, comparative negligence, vandalism/malicious mischief, special investigation), property damage liability, and rental vehicle coverages
  • Negotiate liability for comparative negligence (claimant or adverse carrier)
  • Identify coverage concerns, reviews prior loss history, determine and create Special Investigation Unit (SIU) referrals, when appropriate
  • Interact with multiple parties to gather information needed to determine liability (police reports, recorded statements, witness statements)
  • Resolve claims through proactive problem solving and decision making, within authority guidelines and under moderate supervision, overcoming obstacles, and effectively prioritizing the workload
  • Clearly documents thought process including damage evaluation, investigation, negotiation, and settlement decisions
  • Collaborate and set expectations with external and internal business partners to facilitate claims resolution through use of varying communication channels to include utilization of digital tools to drive timely and effective resolutions through exceptional service
  • Investigates, reviews, and accepts or rejects moderately complex coverage and other potential coverage; and investigates coverage denial questions
  • Handles specialized claims

Claims IM Fraud Specialist

  • Analyzed the current scenario of an organization, locate, and highlight certain issues which requires immediate response, and allows the organization to track that critical problem, monitor it appropriately, and manage the escalating situation
  • Investigated fraud claims involving ACH, Pre-authorized drafts, altered check, forged endorsements, unauthorized third-party transfers, elder fraud, identity theft or other operations fraud issues
  • Reviewed, verified and/or identified customer transactions to detect/prevent fraud, policy violations or resolve merchant disputes to mitigate and/or recover losses
  • Resolved customer complaints and concerns with strong verbal and negotiation skills
  • Used established procedures and significant job experience to carry out and resolve moderately complex to complex work assignments and conducts member research as necessary
  • Researched moderate complex account activity, determines potential source of compromise, and then takes the appropriate action to decide the case using multiple systems and applications

FHL Fraud Specialist I

  • Approach problems logically to resolve conflicts and manage customer expectations
  • Are able to navigate multiple technologies while staying engaged with our customers
  • Demonstrate resiliency and extreme adaptability in a fast paced environment
  • Possess strong customer focus with the ability to have detailed conversations with our customers
  • Take ownership of each customer interaction while treating customers with respect and responding with empathy
  • Trained in Deposit Review, Electronic Money Movement, and Compliance (KYC, Power of Attorney, Rep Payee, VA Custodial, Trust, and Estate) under Fraud Hotline
  • Demonstrate personal excellence including punctuality, integrity, and accountability
  • Make appropriate decisions on behalf of our customers quickly and effectively

Education

Bachelor of Arts - General Studies, concentration in Communication Essentials

Southern New Hampshire University
11-2024

Skills

  • Regulatory Compliance
  • Complaint resolution
  • Performance Improvement
  • Analytical Problem Solving
  • Teamwork and leadership
  • Detail oriented

Certification

Claims Adjuster All Lines

Accomplishments

  • Presidents list
  • Honors

Timeline

Claims Adjuster

USAA
10.2023

Fulfillment Account Specialist II

JP Morgan Chase
03.2019 - 10.2023

Dental Consultant

UnitedHealth Group
09.2017 - 09.2018

Onsite Management Dispatcher

Hewlett Packard Enterprise/conduit global
12.2016 - 09.2017

Loan Processor

Aerotek-F4F
12.2014 - 10.2016

Claims IM Fraud Specialist

FHL Fraud Specialist I

Bachelor of Arts - General Studies, concentration in Communication Essentials

Southern New Hampshire University

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Karisha McClinton