Proven Claims Specialist with a track record of enhancing customer satisfaction and streamlining claims processes at Health Advocate Services. Leveraging critical thinking and exceptional organizational skills, consistently achieved performance targets. Excelled in high-pressure situations, demonstrating professionalism and empathy, contributing to improved client trust and efficient dispute resolution. Detail-oriented team player with strong organizational skills. Ability to handle multiple projects simultaneously with a high degree of accuracy. Organized and dependable candidate successful at managing multiple priorities with a positive attitude. Willingness to take on added responsibilities to meet team goals.
Hi, I’m
Regenia Caudle
Kissimmee,FL
Summary
Overview
13
years of professional experience
Work History
Health Advocate Services
Claims Specialist
10.2021 - 08.2024
Job overview
- Managed a high volume of claims effectively by prioritizing tasks and maintaining excellent organizational skills.
- Enhanced customer satisfaction with timely communication, empathy, and clear explanations of claim outcomes.
- Settled complex claims fairly by applying critical thinking, negotiation skills, and detailed knowledge of insurance policies.
- Handled high-pressure situations with professionalism and composure, consistently achieving positive outcomes for both clients and the organization.
- Followed up with customers on unresolved issues.
- Provided exceptional customer service during stressful situations by offering empathy and support while resolving issues efficiently.
- Achieved performance targets consistently through attention to detail, effective time management, and strong decision-making abilities.
- Reviewed insurance and claims documents to verify required information and secure any missing data for settlements.
- Maintained accurate records by diligently updating claim files and ensuring all required documentation was submitted in a timely manner.
- Enhanced customer trust and satisfaction by efficiently resolving claims disputes.
Houghton Mifflin Harcourt Publishing Company
Customer Service Representative
03.2015 - 10.2021
Job overview
- 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.
- Developed strong product knowledge to provide informed recommendations based on individual customer needs.
- Developed rapport with customers through active listening skills, leading to higher retention rates and positive feedback from clients.
- Assisted customers in navigating company website and placing online orders, improving overall user experience.
- Collaborated with team members to develop best practices for consistent customer service delivery.
- Provided coaching and mentoring to new hires, contributing to their successful integration into the team.
- Participated in cross-functional teams to discuss ways to improve overall customer satisfaction across company.
- Fostered positive customer service culture within team which led to higher customer satisfaction rates.
- Participated in training programs to enhance product knowledge and customer service skills.
- Coordinated with logistics department to expedite shipping for urgent customer orders.
- Trained new Customer Service Representatives on company policies, procedures, and best practices.
- Resolved escalated customer issues, restoring confidence in company's commitment to service excellence.
- Addressed customer inquiries to ensure satisfaction and foster positive service experience.
- Delivered exceptional customer service to every customer by leveraging extensive knowledge of products and services and creating welcoming, positive experiences.
- Exhibited high energy and professionalism when dealing with clients and staff.
- Investigated and resolved customer inquiries and complaints quickly.
- Delivered prompt service to prioritize customer needs.
- Met customer call guidelines for service levels, handle time and productivity.
- Educated customers about billing, payment processing and support policies and procedures.
- Responded proactively and positively to rapid change.
- Promptly responded to inquiries and requests from prospective customers.
- Developed highly empathetic client relationships and earned reputation for exceeding service standard goals.
Executive Health Resources
Claims Intake Specialist
10.2011 - 02.2014
Job overview
- Maintained a high level of accuracy in data entry, ensuring the seamless flow of information between systems and teams.
- Provided support to case managers as needed, assisting with research or documentation requests for ongoing claims investigations.
- Demonstrated adaptability by quickly learning updates to company policies or software changes affecting the claims process.
- Supported departmental goals by consistently meeting or exceeding assigned productivity metrics and quality standards.
- Handled sensitive client information with discretion, adhering to strict privacy policies and confidentiality standards at all times.
- Contributed to a positive work atmosphere by actively participating in team meetings and openly discussing challenges and potential solutions.
- Managed workload and priorities to meet claims processing meet deadlines.
Education
Central Piedmont Community CollegeCharlotte, NC
No Degree from American And English Literature
University Overview
University of Maryland - College ParkCollege Park, MD
No Degree from Pre-Medicine
University Overview
Paine CollegeAugusta, GA
No Degree from Pre-Medicine
University Overview
Skills
- Claims
- Claims Processing
- Claims Investigation
- Verbal Communication
- Microsoft Office
- Coverage assessments
- Claims analysis
- Documentation Review
- Time Management
- Decision-Making
- Critical Thinking
- Customer Service
- Organizing and Prioritizing Work
- Attention to Detail
- Teamwork and Collaboration
- Interpersonal Communication
- Multitasking Abilities
- Problem-Solving
- Insurance Coverage Verification
- Documentation abilities
- Documentation skills
- Information Verification
- Eligibility Determination
- Active Listening
- Claim Amount Calculations
- Data Entry
- Coverage Determination
- Denied claims identification
- Understanding of medical terms
- Regulatory Compliance Adherence
- Records Management
- Reporting skills
- Reporting abilities
- Data Entry Software
- Insurance Claim Forms Review
- Written Communication
- Documentation processing
- Analytical Thinking
- Task Prioritization
- Medical Terminology
- Document Control
- Patient Rapport
- Excellent administrative abilities
- Application Review
- Business Correspondence
- Google Suite Proficiency
- Data Integrity
- Large-Sum Computations
- Paperwork Processing
- Composing Business Correspondence
- Problem-solving abilities
- Reliability
- Excellent Communication
- Organizational Skills
- Effective Communication
- Adaptability and Flexibility
- Self Motivation
- Interpersonal Skills
- Professionalism
- Time management abilities
- Adaptability
- Professional Demeanor
- Analytical Skills
Availability
See my work availability
Not Available
Available
monday
tuesday
wednesday
thursday
friday
saturday
sunday
morning
afternoon
evening
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Timeline
Claims Specialist
Health Advocate Services
10.2021 - 08.2024
Customer Service Representative
Houghton Mifflin Harcourt Publishing Company
03.2015 - 10.2021
Claims Intake Specialist
Executive Health Resources
10.2011 - 02.2014
Central Piedmont Community College
No Degree from American And English Literature
University of Maryland - College Park
No Degree from Pre-Medicine
Paine College
No Degree from Pre-Medicine
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