Krystin Gordon
Garland
Summary
Dedicated and detail-oriented Claims Specialist with 5 years of experience in processing claims across various lines of business. Skilled in reviewing and verifying claims, ensuring compliance with industry standards, and collaborating with internal teams for seamless resolution. Adept at managing claims using specialized software and providing exceptional service to policyholders. Proven track record as a Remote Claims Processor and Claims Associate, consistently delivering accuracy, efficiency, and professionalism in a remote setting.
Overview
8
8
years of professional experience
Work History
Claims Processor (Remote)
Premera Blue Cross, BCBS Association
10.2023 - Current
- I maintained compliance with company policies and regulatory requirements, while ensuring quality, accuracy, and turnaround on processing high-volume claims daily
- Reviewed claims for accuracy and proper documentation needed for underwriting and final approval
- Worked with adjusters, underwriters, and customer service reps to address discrepancies and expedite claims
- Tracked each claim, using claims management software, and prepared comprehensive reports for the management
- Continuously followed up with clients to provide claim status updates and assistance when needed
Claims Specialist (Temp)
Cigna
04.2022 - 10.2023
- Processed more advanced-level claims from beginning up to and including closure, verifying documentation; working with involved parties, and closing the process on time
- Collaborated with internal parties in terms of Indeed solutions
- Above all, sought to avoid delayed resolution of claims escalations by providing them worked out
- Implemented standards and procedures, supervised the preparation of available documentation, also recruited and assured adherence to guidelines
- Identified and referred suspicious or possible fraudulent claims to the fraud investigation unit for further handling
Customer Service Representative
Toyota Financial Services
07.2021 - 04.2022
- Settled complex claims fairly by applying critical thinking, negotiation skills, and detailed knowledge of insurance policies.
- Managed high call volumes while providing exceptional customer support and maintaining professional composure.
- Collaborated with team members to share best practices and improve overall team performance in meeting targets.
- Exceeded monthly performance metrics consistently, contributing to the success of the call center operations.
Claims Representative Associate
State Farm
12.2019 - 03.2020
- Improved claim resolution times by efficiently processing and investigating claims.
- Collaborated with legal teams to successfully defend against fraudulent claims.
- Conducted thorough investigations by gathering relevant information from various sources.
- Streamlined communication between departments to expedite the claims process.
Refinance Specialist
Capital One
07.2018 - 10.2019
- Helped meet changing demands by recommending improvements to business systems or procedures.
- Gathered, organized and input information into digital database.
- Followed up with customers about resolved issues to maintain high standards of customer service.
- Increased efficiency and team productivity by promoting operational best practices.
Claims Associate
Myriad Genetics
09.2016 - 11.2017
- Functioned as a liaison to the claims team through managing a book of claims, review of initial claim submissions, and providing them METLIFE trusted documents
- I assisted in the final review and approval of claims to ensure overall compliance with all regulatory and policy requirements
- I recorded all claim activities while maintaining detailed documentation for auditing and reporting functions
- Handled inquiries from policyholders and accurately conveyed information on claims status, where required
- Resolved simple issues
- Worked with senior claims processor to escalate challenging claims and ensure timely resolution
Education
Associate of Science -
Collin County Community College
Plano, TXHigh School Diploma -
South Garland High School
Garland, TX06-2009
Skills
- Claims Processing
- Claims review
- Claims Management Software
- Documentation & Data Accuracy
- Transactions reconciliation
- Payments posting
- Regulatory Compliance
- Allocating claims
- Policy Interpretation
- Data Entry
- Microsoft Office
- Settlement determinations
- Coverage assessments
- Problem-Solving
- Team Collaboration
- Time Management
- Email Etiquette
Timeline
Claims Processor (Remote)
Premera Blue Cross, BCBS Association
10.2023 - Current
Claims Specialist (Temp)
Cigna
04.2022 - 10.2023
Customer Service Representative
Toyota Financial Services
07.2021 - 04.2022
Claims Representative Associate
State Farm
12.2019 - 03.2020
Refinance Specialist
Capital One
07.2018 - 10.2019
Claims Associate
Myriad Genetics
09.2016 - 11.2017
Associate of Science -
Collin County Community College
High School Diploma -
South Garland High School
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