Keosha Swann
Concord,NC
Summary
Experienced customer service professional with a strong background in the financial and healthcare sectors. Proficient in fraud detection, claims processing, and providing coaching to ensure optimal service delivery. Seeking a customer service role to utilize expertise in training, policy adherence, and enhancing customer satisfaction.
Overview
9
9
years of professional experience
1
1
Certification
Work History
Fraud & Claims OPS Rep-Banker Coach
Wells Fargo
10.2023 - Current
- Develop and implement training materials to enhance understanding of new systems, policies, and best practices for operational efficiency
- Communicate with management to resolve discrepancies and improve financial practices within the organization
- Analyze data and metrics to identify trends and provide targeted feedback for improved customer service and compliance with job rules and regulations
Fraud & Claims Operations Representative
Wells Fargo
09.2022 - Current
- Conducts thorough research and verification of customer transactions to identify and prevent financial crime activities and ensure compliance with policies
- Analyzes patterns and trends to effectively mitigate potential fraud-related losses
- Refers complex cases involving account takeover, elder abuse, and various types of fraud to appropriate channels for further investigation
- Serves as a Subject Matter Expert, offering policy and procedure guidance to team members and assisting with training initiatives for both new and established employees
Medical Claim Processor
Aetna
10.2019 - 09.2022
- Evaluated health plan coverage to determine member benefits and entitlements.
- Navigated complex software platforms to document and retrieve essential claim data
- Evaluated medical claims to ascertain the specifics of a member's illness or injury and identified cost management prospects
- Maintained high accuracy in claim processing, contributing to customer satisfaction and meeting organizational quality and productivity benchmarks
- Inpatient coding experience with DRG knowledge , outpatient coding experience ICD 10 HCPC and CPT codes
Account Representative
PRA
11.2017 - 04.2019
- Managed a portfolio of multiple accounts, ensuring timely delivery of products and services while maintaining strong relationships with clients.
- Provided regular performance updates to management on account portfolio status, ensuring transparency throughout the organization.
- Monitored service after sale and implemented quick and effective problem resolutions.
- Developed and maintained strong working relationships with professionals within assigned territory.
- Resolved client disputes professionally, contributing to enhanced brand reputation and client trust.
- Identified new business opportunities through cold calling, networking, marketing and prospective database leads.
Client Service Representative
BB&T
10.2015 - 06.2016
- Delivered outstanding customer service by maintaining a professional demeanor during high-pressure situations.
- Adapted quickly to changes in company policy or procedures while maintaining excellent service standards for existing clients.
- Managed incoming calls, providing prompt and accurate information to clients about products and services.
- Utilized active listening skills to identify customer needs and provide appropriate solutions.
- Helped large volume of customers every day with positive attitude and focus on customer satisfaction.
- Handled sensitive client information with discretion, ensuring confidentiality at all times.
- Developed strong relationships with clients through proactive outreach and regular check-ins on progress and satisfaction.
- Delivered exceptional customer service to every customer by leveraging extensive knowledge of products and services and creating welcoming, positive experiences.
Education
Associates - Human Services Technology
Forsyth Technical Community College
05.2019
Certification - Human Services Technology-Foundational Skills
Forsyth Technical Community College
04.2019
Certification - Early Childhood Credential
Guilford Technical Community College
07.2013
Diploma -
Ben L. Smith High School
06.2009
Skills
- Microsoft Office
- Coaching Skills
- Developing Skills
- Researching
- Policies and Procedures
- Leadership Skills
- Customer Service Skills
- Active Listening
- Critical Thinking
- Communication Skills
- Reporting/Documentation
Certification
- Certification in Human Services Technology-Foundational Skills, Forsyth Technical Community College, 04/01/19
- Certification in Early Childhood Credential, Guilford Technical Community College, 07/01/13
Timeline
Fraud & Claims OPS Rep-Banker Coach
Wells Fargo
10.2023 - Current
Fraud & Claims Operations Representative
Wells Fargo
09.2022 - Current
Medical Claim Processor
Aetna
10.2019 - 09.2022
Account Representative
PRA
11.2017 - 04.2019
Client Service Representative
BB&T
10.2015 - 06.2016
Associates - Human Services Technology
Forsyth Technical Community College
Certification - Human Services Technology-Foundational Skills
Forsyth Technical Community College
Certification - Early Childhood Credential
Guilford Technical Community College
Diploma -
Ben L. Smith High School
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