Melissa Morales
Winston
Summary
Seasoned Senior Claims Examiner with a proven track record at Tata Consultancy and Transamerica Life Insurance Company. Excelled in reducing claim resolution times and enhancing customer satisfaction through expert claims analysis and empathetic communication. Skilled in Microsoft Office Suite and adept at managing high-stress situations, consistently delivering satisfactory outcomes and mitigating risks.
Overview
12
12
years of professional experience
Work History
Senior Claims Examiner
Tata Consultancy
04.2018 - 01.2025
- Reduced claim resolution time by conducting thorough investigations and timely decisionmaking.
- Handled high-profile cases professionally, maintaining confidentiality while achieving satisfactory resolutions.
- Mitigated company risk by identifying fraudulent activities and implementing preventative measures.
- Prepared detailed reports on claim activity for management review, highlighting areas for improvement.
- Enhanced customer satisfaction through prompt communication and comprehensive claim explanations.
Claims Examiner
Transamerica Life Insurance Company
02.2015 - 04.2018
- Handled sensitive information with discretion, ensuring confidentiality of personal and financial details for claimants throughout the claims examination process.
- Utilized analytical skills to evaluate medical bills for accuracy and appropriateness of charges before approving payments as part of the claims process.
- Participated in cross-functional team meetings to address organizational challenges related to claims management and develop solutions collaboratively.
- Reduced claim processing time by implementing efficient workflow strategies and prioritizing tasks effectively.
- Enhanced customer satisfaction by promptly addressing inquiries and providing accurate information on claim status.
- Maintained detailed records of all claims activities, ensuring compliance with regulatory requirements and company policies.
Customer Service Representative
Transamerica Life Insurance Company
09.2012 - 03.2015
- Managed high-stress situations effectively, maintaining professionalism under pressure while resolving disputes or conflicts.
- Resolved customer complaints with empathy, resulting in increased loyalty and repeat business.
- Handled escalated calls efficiently, finding satisfactory resolutions for both customers and the company alike.
- Responded to customer requests for products, services, and company information.
- Enhanced customer satisfaction by promptly addressing concerns and providing accurate information.
Education
High School Diploma -
Coatesville Area High School
Coatesville, PASkills
- Claims analysis
- File and record management
- Data entry
- Coverage evaluation
- Call center experience
- Computer proficiency
- Claim resolution
- Microsoft Excel
- Verbal communication
- Microsoft Office Suite
- Microsoft outlook
Languages
Spanish
Native or Bilingual
English
Native or Bilingual
Timeline
Senior Claims Examiner
Tata Consultancy
04.2018 - 01.2025
Claims Examiner
Transamerica Life Insurance Company
02.2015 - 04.2018
Customer Service Representative
Transamerica Life Insurance Company
09.2012 - 03.2015
High School Diploma -
Coatesville Area High School
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