Miesha Smith
Winter Haven
Summary
Friendly Insurance Verification Specialist promoting a background in keeping sensitive patient data confidential while maintaining knowledge of Medicaid and private policy benefits. Possessing great relationship building and communication skills. Looking to tackle new challenges with a company that values dynamic skills and a strong work ethic.
Efficient Claims Processor known for high productivity and task completion. Possess specialized skills in claims analysis, documentation verification, and regulatory compliance ensuring smooth operation flow. Excel in time management, problem-solving, and communication, leveraging these soft skills to effectively manage workloads and facilitate clear interactions with all stakeholders.
Overview
15
15
years of professional experience
Work History
Claims Processor
GEICO
Lakeland
12.2015 - Current
- Participated in audits of claims files to ensure adherence to company policies.
- Entered claim information accurately into database systems.
- Corresponded with providers regarding any missing or incomplete documentation needed for successful adjudication of claims.
- Utilized computer systems such as Microsoft Office Suite and specialized software programs used by the company.
- Evaluated performance metrics regularly; suggested modifications where necessary for increased efficiency.
- Prepared detailed reports on investigation findings and claim status for internal use.
- Explained loss coverage, assisted policyholders with itemizing damages and coordinated alternative living arrangements.
- Investigated questionable claims to determine payment authorization.
- Determined reserves for each claim based on estimated costs of settlement or defense.
- Input claim information and payments into company database.
- Analyzed and audited open claims to calculate additional payments owed.
- Reviewed and applied state laws and regulations to ensure compliance in claim handling.
- Conducted on-site inspections of property damage to assess repair needs and costs.
- Explained premiums owed to policyholders, agents and underwriters.
- Collaborated with underwriting teams to provide insights on risk assessment and policy adjustments.
- Coordinated with law enforcement and other agencies as needed for claims investigation.
Customer Service Representative
Spectrum
Auburndale
10.2015 - 04.2020
- Prepared and evaluated CRM reports to identify problems and areas for improvement.
- Asked probing questions to determine service needs and accurately input information into electronic systems.
- Utilized job-related software to prepare change of address records and issue service discontinuance orders.
- Tracked orders from start to finish to ensure timely delivery of goods or services.
- Used approved scripts to de-escalate angry customers during telephone interactions.
- Conducted regular follow-up calls with customers after resolving their issues.
- Remained calm and professional in stressful circumstances and effectively diffused tense situations.
- Monitored customer satisfaction levels through surveys and feedback forms.
- Developed strong relationships with customers by providing personalized assistance and support.
- Identified opportunities for upselling additional products or services based on customer needs.
- Answered customer inquiries via phone, email, and chat.
Customer Service Representative
Centene
Winter Haven
06.2010 - 09.2015
- Prepared and evaluated CRM reports to identify problems and areas for improvement.
- Asked probing questions to determine service needs and accurately input information into electronic systems.
- Utilized job-related software to prepare change of address records and issue service discontinuance orders.
- Used approved scripts to de-escalate angry customers during telephone interactions.
- Tracked orders from start to finish to ensure timely delivery of goods or services.
- Gathered customer feedback through surveys and used the data to improve customer service.
- Conducted regular follow-up calls with customers after resolving their issues.
- Implemented innovative methods for streamlining the customer service process.
- Identified areas of improvement in customer service processes and suggested changes accordingly.
- Recommended improvements in products, service and billing methods to management to prevent future problems.
Education
High School Diploma -
Christian Academy Inc
Winter Haven, FL05-2010
Skills
- Claims processing
- Regulatory compliance
- Data entry
- Risk assessment
- Claims investigation
- Report preparation
- Customer service
- Database management
- Auditing claims
- Effective communication
- Problem solving
- Attention to detail
- Collaboration skills
- Time management
- Software utilization
Timeline
Claims Processor
GEICO
12.2015 - Current
Customer Service Representative
Spectrum
10.2015 - 04.2020
Customer Service Representative
Centene
06.2010 - 09.2015
High School Diploma -
Christian Academy Inc