Malaijah Calloway
Dothan
Summary
Dynamic Claim Specialist with expertise in claims investigation and exceptional customer service, honed at Cigna. Proven ability to resolve billing disputes and enhance processes while maintaining compliance. Proficient at multitasking and active listening, ensuring swift eligibility determinations, and superior client satisfaction. Committed to delivering impactful solutions in a fast-paced environment.
Highly dedicated and organized professional with experience in the insurance industry. Expertise in claims processing, policy evaluation, claims review, and data entry. Proven track record of accurately and efficiently processing high volumes of claims while adhering to strict company policies. Focused on providing superior customer service and maintaining positive customer relationships.
Overview
4
4
years of professional experience
Work History
Claim Specialist/Work From Home Agent
Cigna
Dothan
03.2024 - 06.2025
- Collaborated with other departments within the organization to resolve any billing disputes quickly and accurately.
- Assisted in the development of new processes related to claim adjudication activities.
- Reviewed policy changes from carriers and updated internal systems accordingly.
- Checked patient's insurance on file.
- Conducted thorough investigations into insurance claims to determine coverage eligibility and appropriate compensation amounts.
- Giving the caller the claim status on the claims as well as verifying benefits and eligibility for the member.
- Managed appeals process from initial submission through final disposition, ensuring compliance with state laws and contractual obligations.
Customer Service Data Entry/Work From Home Agent
Aetna
Dothan
12.2022 - 02.2024
- Handled customer complaints and inquiries in a courteous and efficient manner.
- Demonstrated excellent communication skills, both verbal and written, in order to effectively interact with customers.
- Developed strong customer relationships and loyalty through effective communication.
- Greeted customers by name and displayed respectful attitude, helping develop rapport with customer base and build lasting relationships.
- Addressed customers courteously using suitable methods and problem-solving skills.
- Utilized problem-solving techniques to identify solutions for complex customer inquiries.
- Assisted customers with product selection by providing detailed information about available products and services.
- Handled escalated calls professionally by listening carefully to the needs of each individual customer before offering appropriate solutions.
- Displayed excellent multitasking abilities, managing simultaneous tasks while maintaining a high level of accuracy and attention to detail.
- Performed data entry tasks accurately and in a timely manner.
Customer Service Representative/Work From Home Agent
Sarnova
Dothan
06.2021 - 11.2022
- Handled customer complaints and inquiries in a courteous and efficient manner.
- Demonstrated excellent communication skills, both verbal and written, in order to effectively interact with customers.
- Developed strong customer relationships and loyalty through effective communication.
- Responded to telephone inquiries and complaints following standard operating procedures.
- Greeted customers by name and displayed respectful attitude, helping develop rapport with customer base and build lasting relationships.
- Utilized problem-solving techniques to identify solutions for complex customer inquiries.
- Monitored daily performance metrics such as call volume, wait times, resolution times.
Education
High School Diploma -
Dale County High School
Midland City 05-2018
Skills
- Claims investigation
- Policy interpretation
- Financial acumen
- Customer service
- Typing speed
- Appointment scheduling
- Issue and complaint resolution
- Multitasking
- Teamwork
- Active listening
- Prior authorization processing
- Computer proficiency
- Microsoft office
- Data entry
- Documentation skills
- Organizing and prioritizing work
- Medical terminology
- Insurance
- Live Chat messaging
- Billing management
- Insurance claim forms review
- Eligibility determination
Languages
English
Full Professional
Timeline
Claim Specialist/Work From Home Agent
Cigna
03.2024 - 06.2025
Customer Service Data Entry/Work From Home Agent
Aetna
12.2022 - 02.2024
Customer Service Representative/Work From Home Agent
Sarnova
06.2021 - 11.2022
High School Diploma -
Dale County High School
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