ROSELINE OHIOMAH
ST PAUL,TX
Summary
Friendly insurance professional experienced in investigating and processing insurance claims. Hardworking and communicative individual excels at interpreting policies and negotiating payment solutions. Recognized for providing optimum service to policyholders and quickly identifying fraudulent claims.
Tactful Claims Specialist with expertise in settlement preparation, claims processing and appeal filing. Diplomatic and personable professional accustomed to handling sensitive, confidential information and investigating complex liability claims. Committed to maintaining customer satisfaction and contributing to company success.
Overview
10
10
years of professional experience
1
1
Certification
Work History
Claims Specialist
Everisepc
07.2022 - Current
- Enhanced customer satisfaction by efficiently handling high call volumes and resolving issues promptly.
- Reduced average call handling time through active listening, empathy, and effective problem-solving skills.
- Achieved high first-call resolution rates by providing accurate information and solutions to customers'' concerns.
- Maintained thorough knowledge of company products, services, and policies to provide consistent support across all calls.
- Developed strong rapport with customers by attentively addressing their needs and fostering a positive service experience.
- Improved team performance by sharing best practices, tips, and techniques for effectively managing customer interactions.
- Consistently met or exceeded monthly performance metrics for call quality, adherence to schedule, and efficiency.
- Assisted in training new hires on company policies, systems, and call handling procedures to ensure seamless integration into the team.
- Collaborated with cross-functional teams to address complex customer issues requiring additional expertise or escalation.
- Identified areas for process improvement within the contact center operations to enhance overall efficiency and customer satisfaction.
- Provided timely feedback on product-related issues encountered by customers to inform improvements in product design or documentation.
- Managed challenging situations calmly while maintaining professionalism throughout interactions with difficult callers.
- Stayed up-to-date on industry trends and advancements in customer service technology to provide informed recommendations for operational enhancements.
- Participated in regular team meetings to discuss performance metrics, share insights, and foster a collaborative work environment.
- Followed up on open cases, ensuring timely resolution and customer satisfaction throughout the process.
- Utilized excellent communication skills in both written and verbal forms to effectively address customer inquiries and concerns.
- Achieved high satisfaction rating through proactive one-call resolutions of customer issues.
- Improved claim processing efficiency by streamlining workflows and implementing time-saving strategies.
- Reduced claim processing errors by conducting thorough investigations and accurately interpreting policy details.
Claims Adjuster
GEICO
02.2020 - 06.2022
- Improved claim resolution times by efficiently managing a caseload of 50+ claims per month.
- Achieved high customer satisfaction ratings by providing clear and timely communication throughout the claims process.
- Negotiated favorable settlements with claimants, attorneys, and other insurance carriers to minimize financial risk for the company.
- Conducted thorough investigations of complex insurance claims, gathering evidence and analyzing relevant documentation.
- Streamlined internal processes by implementing new claims management software, increasing overall productivity.
- Collaborated with legal teams to defend against fraudulent claims, saving company resources and maintaining its reputation.
- Mentored junior adjusters on best practices and industry regulations, contributing to their professional growth and development.
- Maintained compliance with state regulatory requirements through meticulous documentation and adherence to company policies.
- Evaluated coverage accurately by interpreting complex insurance policies and applying them to specific claim scenarios.
- Identified potential fraud indicators early in the investigation process, protecting company assets from potential losses due to fraudulent activity.
- Assisted in updating training materials for new hires based on evolving industry standards and best practices.
- Coordinated with medical professionals to evaluate injury claims fairly while ensuring policyholder needs were met throughout the healing process.
Customer Service/Call Center Agent
Mckesson Corporation
11.2016 - 12.2020
- Enhanced customer satisfaction by efficiently handling high call volumes and resolving issues promptly.
- Reduced average call handling time through active listening, empathy, and effective problem-solving skills.
- Achieved high first-call resolution rates by providing accurate information and solutions to customers'' concerns.
- Maintained thorough knowledge of company products, services, and policies to provide consistent support across all calls.
- Consistently met or exceeded monthly performance metrics for call quality, adherence to schedule, and efficiency.
- Collaborated with cross-functional teams to address complex customer issues requiring additional expertise or escalation.
- Assisted in training new hires on company policies, systems, and call handling procedures to ensure seamless integration into the team.
- Provided timely feedback on product-related issues encountered by customers to inform improvements in product design or documentation.
- Managed challenging situations calmly while maintaining professionalism throughout interactions with difficult callers.
- Participated in regular team meetings to discuss performance metrics, share insights, and foster a collaborative work environment.
- Recognized as a top performer among peers due to consistently exceeding expectations for call quality and customer satisfaction scores.
- Emphasized a customer-centric approach in all interactions by placing their needs and expectations at the forefront of each call.
Account Payable Specialist
ROBERT HALL CONSTRUCTION
05.2014 - 09.2016
- Streamlined accounts payable processes by implementing efficient invoicing and payment tracking systems.
- Reduced invoice processing time with accurate data entry and timely vendor communication.
- Improved cash flow management by negotiating favorable payment terms with suppliers.
- Enhanced financial accuracy through diligent reconciliation of vendor statements and company records.
- Collaborated with procurement team to resolve discrepancies between purchase orders and invoices received.
- Assisted in the preparation of monthly financial statements by providing accurate accounts payable information.
- Ensured timely payments for all invoices, maintaining strong relationships with vendors and suppliers.
- Implemented a new system for organizing physical and electronic records, reducing document retrieval time significantly.
- Trained junior staff members in accounts payable procedures, increasing overall department efficiency.
- Conducted thorough audits of expense reports, identifying opportunities for cost savings within the organization.
- Contributed to year-end closing process by ensuring all outstanding payables were accurately recorded and settled promptly.
- Maintained compliance with internal controls and external regulations related to accounts payable processes.
- Supported accounting team during annual budgeting process by providing detailed analysis of historical expenditure data.
Education
No Degree -
All Lines Adjuster
Associate of Science - Vocational Nursing
Concord Career College
Grand Prairie, TX11.2011
Bachelor of Science - Medical Laboratory Sciences
Ambrose Alli University
Edo State, Nigeria11.2008
Skills
- Documentation Review
- Coverage Assessments
- Settlement Determinations
- Accident Investigations
- Claims Analysis
- Microsoft Office
- Estimate Preparation
- Claims Processing
- Compliance Management
- Time Management
- Verbal Communication
- Claims Investigation
- Organizational Skills
- Conflict Resolution
- Multitasking Abilities
- Computer Proficiency
- Insurance Knowledge
- Fraud Detection
- Regulatory Compliance
- Attention to Detail
- Problem Solving
- Analytical Skills
- Critical Thinking
- Active Listening
- Written Communication
- Decision Making
- Ethical Conduct
- Case Management
- Customer Service
- Teamwork and Collaboration
- Claim Amount Calculations
Certification
All Lines Ldjuster
Texas Department of Adjuster, TX, United States
Timeline
Claims Specialist
Everisepc
07.2022 - Current
Claims Adjuster
GEICO
02.2020 - 06.2022
Customer Service/Call Center Agent
Mckesson Corporation
11.2016 - 12.2020
Account Payable Specialist
ROBERT HALL CONSTRUCTION
05.2014 - 09.2016
No Degree -
All Lines Adjuster
Associate of Science - Vocational Nursing
Concord Career College
Bachelor of Science - Medical Laboratory Sciences
Ambrose Alli University
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