RAFFELL JOHNSON
Dallas,TX
Summary
Professional claims specialist with strong record in handling and resolving complex claims efficiently. Adept at analyzing data, identifying discrepancies, and providing solutions that drive positive outcomes. Effective team collaborator with focus on achieving results and adapting to evolving requirements. Skilled in negotiation, customer service, and regulatory compliance, consistently ensuring accuracy and fairness.
Overview
7
7
years of professional experience
Work History
Claims Specialist II
GEICO
09.2024 - Current
- Reviewed intricate claims to determine eligibility status while ensuring alignment with established company policies.
- Reviewed and processed insurance claims efficiently, maintaining high accuracy standards.
- Coordinated communication between clients and internal teams to resolve claim inquiries.
- Mentored junior staff on best practices for claims processing and customer service excellence.
- Implemented process improvements that enhanced workflow efficiency and reduced claim resolution time.
- Enhanced customer satisfaction with timely communication, empathy, and clear explanations of claim outcomes.
- Managed a high volume of claims effectively by prioritizing tasks and maintaining excellent organizational skills.
- Collaborated with cross-functional teams to optimize claims handling procedures, resulting in improved productivity.
Claims Specialist
TATA Consultancy Services
03.2022 - 08.2024
- Oversaw and processed insurance claims in a high-volume setting.
- Delivered exceptional customer service by addressing client claims inquiries with efficiency.
- Evaluated and assessed insurance policies to establish coverage eligibility for claims.
- Facilitated negotiations of settlements with third-party vendors to optimize cost efficiency for insurance company.
- Facilitated training sessions for new employees on claim processing procedures and policies.
- Oversaw meticulous documentation of all claims activities to ensure compliance and accuracy.
Dietitian Assistant
Medical City Lewisville
07.2019 - 02.2022
- Conducted dietary assessments and developed individualized meal plans for clients.
- Provided nutrition education and counseling to help clients achieve their health goals.
- Assisted in menu planning and food preparation for special diets and events.
- Collaborated with interdisciplinary team members to coordinate patient care and treatment plans.
- Maintained accurate records of client progress and dietary changes.
- Participated in community outreach programs to promote healthy eating habits.
- Stayed current on nutrition research and trends to provide evidence-based recommendations.
Education
Communication Studies
Texas State University
San Marcos, TX05-2002
Skills
- Communication
- Problem-solving
- Time management
- Empathy
- Conflict resolution
- Adaptability
- Attention to detail
- Multi-tasking
- Organizational
- Research
- Coverage assessments
- Policy interpretation
- Documentation review
- Liability denials
- Interpersonal communication
- Analytical thinking
- Written communication
- Insurance claim forms review
- Data entry software
- Reporting skills
- Regulatory compliance adherence
LANGUAGES
English — Native
Timeline
Claims Specialist II
GEICO
09.2024 - Current
Claims Specialist
TATA Consultancy Services
03.2022 - 08.2024
Dietitian Assistant
Medical City Lewisville
07.2019 - 02.2022
Communication Studies
Texas State University