Reneika Tookes
Atlanta,GA
Summary
Customer service results-driven with extensive experience in claims handling. Skilled in managing complex claims, resolving policyholder concerns and delivering efficient , compliant solutions. Proven ability to analyze courage, communicate clearly with clients and provide high quality support.
Overview
16
16
years of professional experience
1
1
Certification
Work History
Claims Specialist
Med Mart Plus
2022.03 - 2025.03
- Evaluated insurance claims for accuracy and compliance with company policies.
- Reviewed medical documentation to determine claim validity and appropriate payout amounts.
- Collaborated with healthcare providers to gather necessary information for claims processing.
- Investigated discrepancies in claims submissions, ensuring resolution and adherence to regulatory standards.
Client Relations Specialist
Care Homes Active Adult Living
2009.02 - 2020.01
- Communicated effectively with clients to explain claim processes and resolve inquiries.
- Mentored junior agents on best practices for claims handling and customer service.
- Analyzed trends in claims data to identify areas for operational improvements.
- Maintained detailed records of all claims activities, ensuring compliance with regulatory requirements and company policies.
- Reduced claims processing time by implementing efficient workflow strategies and prioritizing tasks.
- Promoted positive working environment by fostering collaboration among team members and encouraging open communication channels.
- Negotiated settlements with claimants, balancing the interests of both insurance company and insured party while maintaining professional relationships.
Education
Bachelor of Science - Business Management
University of Phoenix
Atlanta, GA2009-08
Skills
- Insurance coverage verification
- Documentation skills
- Call Management tools & Proficient in CRM systems
- Performance
- Product Mastery
Certification
- Licensed [Property & Casualty Insurance] - [Georgia]
(Active)
Timeline
Claims Specialist
Med Mart Plus
2022.03 - 2025.03
Client Relations Specialist
Care Homes Active Adult Living
2009.02 - 2020.01
Bachelor of Science - Business Management
University of Phoenix