Shaniqua Holyfield-Johnson
Harper Woods
Summary
Detail-oriented Claims Resolution Specialist with extensive experience in resolving complex claims issues. Skilled in facilitating communication and collaborating with healthcare providers to improve claims accuracy and customer satisfaction. Committed to enhancing operational efficiency and compliance.
Overview
12
12
years of professional experience
1
1
Certification
Work History
Claims Resolution Specialist
Ascension Hospital
Troy, MI
08.2023 - Current
- Analyzed claims data to identify trends and discrepancies, improving accuracy of submissions.
- Resolved complex claims issues, ensuring compliance with hospital policies and regulations.
- Collaborated with healthcare providers to gather necessary documentation for claim processing.
- Facilitated communication between departments to streamline claims resolution processes.
- Reviewed adjudicated claims for potential errors, recommending corrective actions as needed.
Claims Representative
General Motors
Detroit, MI
06.2019 - 08.2023
- Processed complex claims efficiently, ensuring accuracy in documentation and compliance with regulationssssssssssssssss.
- Assigned all new claims to the claim staff
- Reduced turnaround time for claim settlements by prioritizing tasks and managing deadlines effectively.
- Provided exceptional customer service, addressing concerns and resolving issues promptly.
- Completed Audits for the claims team
- Developed training materials for new hires, focusing on operational procedures and system navigation.
- Worked productively in a fast-moving a work environment to process large volumes of claims.
- Collaborated with cross-functional teams to expedite complex claims investigations and resolutions.
Claims Processor
Kauman Financial Group
Farmington Hills, MI
01.2018 - 03.2019
- Process and evaluate insurance claims for accuracy and compliance with company policies.
- Followed up with customers on unresolved issues.
- Collaborated with team members to streamline processes, enhancing overall service efficiency.
- Developed strategies to improve customer satisfaction based on feedback analysis and trends.
- Developed strong product knowledge to provide informed recommendations based on individual customer needs.
Assistant Bank Manager
Citizens Bank
Grosse Pointe, MI
01.2015 - 01.2019
- Trained and mentored staff on customer service best practices and sales techniques.
- Developed strategies to enhance customer satisfaction and retention rates.
- Oversaw branch performance metrics, driving improvements in productivity and service delivery.
- Led team meetings to align objectives and foster a positive working environment.
- Oversaw a team of 5.
- Observed, coached and developed bankers in support of reaching performance objectives.
- Completed daily, monthly and yearly audits of the cash vault and the tellers' cash drawers.
- Increased cross-selling opportunities by creating targeted marketing campaigns tailored towards existing clients'' needs.
- Reduced teller errors by implementing comprehensive cash handling training sessions.
Education
BBA - Business Management
University of Phoenix
Tempe, AZ08-2027
Computer Applications - Business Administration
Dorsey Business School
Madison Heights, MI06-2003
Skills
- Claims analysis
- Claims documentation
- Claims underwriting
- Claim adjustments
- Claims evaluation
- Documentation skills
- Customer service
- Customer relations
- Computer skills
- Time management
- Attention to detail
- Decision-making skills
- Problem-solving
- Team leadership
- Active listening
Accomplishments
- Promoted products and encouraged customers to upgrade their existing product plans.
- Customer Relations - Achieved the highest ratings for customer satisfaction across the entire company.
- Product Promotion - Up-sold products and motivated customers to upgrade current product plans.
Certification
- Property & Casualty Insurance License
Timeline
Claims Resolution Specialist
Ascension Hospital
08.2023 - Current
Claims Representative
General Motors
06.2019 - 08.2023
Claims Processor
Kauman Financial Group
01.2018 - 03.2019
Assistant Bank Manager
Citizens Bank
01.2015 - 01.2019
BBA - Business Management
University of Phoenix
Computer Applications - Business Administration
Dorsey Business School