Shana Thompson
Tampa
Summary
Adept claims examiner who significantly enhanced customer satisfaction by having expert knowledge of FMLA and short term disability.
efficiently reviewed claims and processed certifications. Also determined their validity to ensure compliance with policy terms.
My expertise in complaint handling and active listening led to increased loyalty and retention, showcasing my leadership and customer service skills.
top-notch skills in oral and written communication, active listening and analytical problem-solving skills. Enhances customer experiences by employing service-oriented behaviors, understanding customer desires, ad providing customized solutions to build loyalty.
Overview
10
10
years of professional experience
Work History
Paid Parental Leave/Short Term Disability Examiner
Sedgwick claims management services
10.2019 - 08.2024
- review insurance claims, determine their validity, and ensure compliance with policy terms. analyze documentation, investigate claims, and collaborate with adjusters and policyholders to resolve cases efficiently. responsibilities also include intake of Family medical leave and Short term disability claims. Reviewing medical certifications and other medical paperwork, approving or denying claims, payments, negotiating settlements, and identifying potential fraud.
- Accurately understand and interpret the various forms and documentation related to claims
- Handled escalated calls efficiently, finding satisfactory resolutions for both customers and the company alike.
- Responded to customer requests for products, services, and company information.
- Processed claims promptly to increase customer satisfaction.
- Developed rapport with customers through active listening skills, leading to higher retention rates and positive feedback from clients.
- May perform other duties as assigned
Customer service specialist
Hearth Insurance Group
07.2018 - 09.2020
- providing excellent support and communication to claimants, healthcare providers, and other clients.
- Answering phone calls and emails from claimants, and other parties regarding claim status, benefits, and policy information.
- Processed customer service orders promptly to increase customer satisfaction.
- Resolved customer complaints with empathy, resulting in increased loyalty and repeat business.
- Providing clear and concise explanations of claims procedures and processes.
- Addressing concerns and questions in a timely and professional manner.
Customer service specialist
Windhaven Insurance
03.2014 - 10.2019
- Managed high call volume while maintaining a courteous and professional demeanor.
- Assisted new employees with training, sharing best practices for handling difficult situations and achieving positive outcomes.
- Enhanced customer satisfaction by resolving issues promptly and professionally.
- Maintained customer satisfaction with forward-thinking strategies focused on addressing customer needs and resolving concerns.
- Developed customer service improvement initiatives to decrease customer wait times.
- Handled escalated calls calmly, finding resolutions that satisfied both the company and the customer's needs.
Education
Diploma -
Clewiston High School
05.2008
6-20 all lines adjustors certification - undefined
Central Insurance school
Skills
- analytical
- communication
- strong attention to detail and knowledge of insurance policies and regulations
- able to analyze large amounts of data, manage multiple claims, and effectively communicate with claimants and other parties
- Team Leadership
- Time Management
- Verbal and written communication
- Complex Problem-Solving
- Staff Training and Development
- Customer Service
- Problem-solving abilities
- Active Listening
- Critical Thinking
- Call center experience
- Money handling abilities
- Complaint Handling
- Payment Processing
- Complaint resolution
Timeline
Paid Parental Leave/Short Term Disability Examiner
Sedgwick claims management services
10.2019 - 08.2024
Customer service specialist
Hearth Insurance Group
07.2018 - 09.2020
Customer service specialist
Windhaven Insurance
03.2014 - 10.2019
6-20 all lines adjustors certification - undefined
Central Insurance school
Diploma -
Clewiston High School
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