Summary
Overview
Work History
Education
Skills
Certification
Timeline
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Shania Davis

Summary

Claims professional who values precision and efficiency in claims evaluation and resolution. Proven track record of managing high caseloads and settling claims accurately in compliance with company standards. Known for strong collaboration with team members and adaptability to changing needs, ensuring reliable performance and positive results.

Overview

7
7
years of professional experience
1
1
Certification

Work History

Sr. Claims Adjuster/ Fraud Triage Specialist

Assurant (American Express)
05.2023 - Current
  • Manage the workflow of fraud triage cases,ensuring that all cases are addressed according to their level urgency.
  • Work closely with client members and senior management to ensure a collaborative approach to fraud detection and mitigation.
  • Oversee the maintenance of accurate records for all cases processed through triage to SIU.
  • Contribute to the development of procedures that enhance the triage team's efficiency in handling high-risk cases.
  • Review flagged claims that have been identified as potentially fraudulent through system and manual referrals.
  • Provide training and guidance to junior triage specialists, to assist with their integration onto the team.
  • Complete a preliminary evaluation of the claims to determine if true red flags are present.
  • Identify suspicious patterns or inconsistencies in the documentation provided.
  • Prepare concise and clear reports summarizing findings for investigators and management.
  • Perform other duties as assigned by management to support the organization's overall mission.


Claims Adjuster/Triage Specialist

Assurant (American Express)
03.2022 - 05.2023
  • Review flagged claims that have been identified as potentially fraudulent through system and manual referrals.
  • Complete a preliminary evaluation of the claims to determine if true red flags are present.
  • Identify suspicious patterns or inconsistencies in the documentation provided.
  • Collaborate with triage team members, fraud investigators, and legal team to provide insights and updates on triaged cases.
  • Prepare concise and clear reports summarizing findings for investigators and management.
  • Leverage fraud detection tools and SIU findings to help assist and support decision-making.

Claims Adjuster

Assurant (American Express)
08.2020 - 03.2022
  • Processed a minimum of 85 claims per week to maintain customer satisfaction and service levels.
  • Reviewed and examined claims filed by cardholders to determine the validity of the claim.
  • Collaborated with management team to help streamline efficiency in the claims process.
  • Ensured all documentation adhered to company policies and legal requirements.
  • Ensured timely and accurate settlement of claims, while balancing the needs of the customer with the expectations of the company.
  • Given coaching/shadowing responsibilities due to high performance to goals.
  • Operated in several roles as needed, to meet client expectations.
  • Maintained customer service satisfaction at an 87% average through excellent up-front and post-claim communication.

Associate Claims Adjuster

Assurant (Citi Bank)
04.2019 - 08.2020
  • Reviewed and examined claims filed by cardholders to determine the validity of the claim.
  • Ensured all documentation adhered to company policies and legal requirements.
  • Ensured timely and accurate settlement of claims, while balancing the needs of the customer with the expectations of the company.
  • Resolved customer questions or concerns related to their claims in a professional and timely manner.
  • Operated in several roles as needed, to meet client expectations.


Customer Care Professional

Assurant (Citi Bank)
01.2019 - 04.2019
  • Serviced existing customers with claim filing, updates, and policy details
  • Maintained detailed records for the client, their policies, and claim statuses
  • Provided excellent white glove customer service by catering to the customer's specific needs and requests
  • Scheduled callbacks between customers and claims adjusters
  • Maintained customer service satisfaction at 92% through rapport building.
  • Handled calls in a time efficient manner which assisted with customer needs and supported the business call queue for a better customer experience.



Crew Trainer

McDonald's
01.2018 - 03.2019
  • Trained on-boarding employees on customer service techniques, food safety and handling, and company expectations
  • Assisted in the hiring, training, and supervising of staff members
  • Assisted managers with adequate training plans that can be integrated throughout the restaurant chain
  • Provided excellent customer care and conflict resolution
  • Monitored employees' attendance and work productivity
  • Guaranteed quality of service through effective communication with customers, staff, and management

Education

High School Diploma -

Robert Morgan Education Center
Miami, FL
06.2017

Skills

  • Excellent analytical and problem-solving skills
  • Strong communication and interpersonal skills
  • Excellent Critical Thinking Skills
  • Strong Listening Skills
  • Excellent Time Management
  • Strong Leadership and mentorship capabilities
  • Highly-Motivated
  • Organized
  • Detail Oriented

Certification

620 All Lines Adjuster Certificate

Timeline

Sr. Claims Adjuster/ Fraud Triage Specialist

Assurant (American Express)
05.2023 - Current

Claims Adjuster/Triage Specialist

Assurant (American Express)
03.2022 - 05.2023

Claims Adjuster

Assurant (American Express)
08.2020 - 03.2022

Associate Claims Adjuster

Assurant (Citi Bank)
04.2019 - 08.2020

Customer Care Professional

Assurant (Citi Bank)
01.2019 - 04.2019

Crew Trainer

McDonald's
01.2018 - 03.2019

High School Diploma -

Robert Morgan Education Center

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Shania Davis