Katonia Updite
Glenn Heights
Summary
Detail-oriented and customer-focused Claims Specialist with over 9 years of experience in claims processing, dispute resolution, and policy compliance. Adept at managing inbound and outbound inquiries, analyzing claims, and ensuring efficient case resolution while maintaining a high level of customer satisfaction. Proven expertise in insurance claims, documentation management, and regulatory compliance.
Recognized for excellence in accuracy, attention to detail, meeting key performance metrics, and effective problem-solving in high-volume environments.
Overview
5
5
years of professional experience
1
1
Certification
Work History
Claims Specialist | Customer Care Professional
Home Care Providers
Richardson, USA
05.2024 - Current
- Process and review claims for accuracy, completeness, and compliance with company policies and regulatory requirements
- Investigate customer claims and collaborate with healthcare providers, pharmacies, and internal departments to ensure prompt resolution
- Maintain an accuracy rate above 95% in claims adjudication and documentation
- Provide timely updates and resolution options to customers while maintaining compliance with HIPAA and insurance policies
- Recognized in the top 20% for customer satisfaction and efficiency among an 800+ agent workforce
Inside Sales & Claims Representative
Tranzact
Dallas, USA
06.2021 - 03.2024
- Conducted outbound calls to prospective clients for life insurance enrollment, verifying eligibility and policy coverage
- Processed insurance claims and policy changes while ensuring compliance with industry regulations
- Maintained a customer satisfaction score above 90% by effectively handling claim inquiries and disputes
- Utilized CRM software to track claims, policyholder information, and case progress
- Awarded top-performing agent status for consistently exceeding sales and claims processing targets
Claims & Customer Service Specialist
AmeriFlex
Carrollton, USA
03.2020 - 06.2021
- Assisted customers with claims processing, reimbursement eligibility, and benefits verification
- Managed a high volume of inbound inquiries regarding flexible spending accounts (FSA) and health savings accounts (HSA)
- Achieved a 52% success rate in resolving claims disputes by providing clear policy guidance and solutions
- Ensured compliance with healthcare and insurance regulations, maintaining accurate records for audit purposes
Education
Bachelor of Science - Health Care Administration
University of Arizona Global Campus
Chandler, AZ10-2024
Skills
- Claims
- Claims processing
- Claims investigation
- Verbal communication
- Claims processing & adjudication
- Insurance policy interpretation
- Case investigation & resolution
- Customer advocacy & support
- Regulatory compliance & documentation
- Fraud detection & risk mitigation
- Data analysis & reporting
- Microsoft Office Suite & CRM software
- Conflict resolution & negotiation
- Time management & multitasking
- Attention to detail & accuracy
- Active listening & empathy
Certification
- Certified Claims Specialist (CCS) – Online Certification (In Progress)
- Microsoft Office Suite (Word, Excel, PowerPoint) – Microsoft, online (2010)
Timeline
Claims Specialist | Customer Care Professional
Home Care Providers
05.2024 - Current
Inside Sales & Claims Representative
Tranzact
06.2021 - 03.2024
Claims & Customer Service Specialist
AmeriFlex
03.2020 - 06.2021
Bachelor of Science - Health Care Administration
University of Arizona Global Campus
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