Shantell Montgomery
Ridgeland,MS
Summary
Results-driven claims representative specializing in data-driven enhancements to customer service processes. Proven ability to manage high volumes of claims while maintaining meticulous attention to detail and compliance with industry standards. Strong communicator adept at resolving complex client issues and fostering positive relationships.
Overview
12
12
years of professional experience
Work History
Claims Representative
UnitedHealth Group
10.2025 - Current
- Reviewed documentation to verify coverage and eligibility requirements.
- Communicated with clients to resolve claim inquiries and issues.
- Processed a high volume of claims efficiently while maintaining quality standards.
- Managed claims processing for health insurance policies efficiently.
- Utilized claims management software to track and process submissions.
- Analyzed claim data to identify trends and process improvements.
- Ensured timely submission of required documentation from claimants prior to approval of payment.
Customer Service Advocate
Centene
06.2023 - 10.2025
- Analyzed customer data trends to identify opportunities for product improvement, enhancing customer satisfaction.
- Utilized strong communication skills to effectively convey product information and benefits to customers.
- Utilized problem-solving techniques to resolve complex customer inquiries and complaints.
- Utilized problem-solving techniques to identify root causes of customer complaints and implemented effective solutions, improving resolution rates.
- Maintained accurate records of all communications with customers.
- Processed and analyzed customer claims with accuracy and attention to detail.
- Adhered to all established policies, procedures, and regulations when dealing with customers.
- Adhered to strict confidentiality guidelines, protecting customer privacy and sensitive data at all times.
- Communicated product information and benefits to customers, fostering informed decision-making and enhancing customer engagement.
- Identified potential opportunities for product improvement by analyzing customer data trends.
Call Center Customer Service Representative
Molina Healthcare Inc.
05.2018 - 12.2022
- Maintained exceptional client service ratings during external audits.
- Delivered fast, friendly and knowledgeable service for routine questions and service complaints.
- Met or exceeded call speed, accuracy and volume benchmarks on consistent basis.
- Evaluated customer account information to assess current issues and determine potential solutions.
- Documented conversations with customers to track requests, problems and solutions.
- Improved service quality and increased sales by developing strong knowledge of company's products and services.
- Cultivated impactful relationships with customers and drove business development by delivering product knowledge.
- Assisting providers with multiple claims inquiries.
- Assisting providers with benefits, eligibility, authorization status.
- Assisting providers with Medicaid, marketplace and Medicare members inquiries.
- Cultivated strong relationships with customers, enhancing product knowledge and fostering business development.
- Achieved top rankings in customer satisfaction, retention, and referrals consistently.
- Assisted providers in checking the status of appeals across all lines of business for efficient follow-up.
Call Center Customer Service Representative
Conduent
07.2015 - 06.2017
- Consulted with customers to determine best methods to resolve service and billing issues.
- Delivered high level of service and support to each customer, paving way for future business opportunities.
- Cultivated strong customer relationships to enhance satisfaction and loyalty through effective product knowledge delivery.
- Reviewed account and service histories to identify recurring issues and provide tailored solutions.
- Evaluated customer account information to assess current issues and determine potential solutions.
- Reviewed account and service histories to identify trends and issues.
- Answered customer questions and addressed concerns, resulting in a reduction in complaint calls.
- Maintained calm, friendly demeanor with upset customers to effectively de-escalate and resolve conflicts.
- Cultivated impactful relationships with customers and drove business development by delivering product knowledge.
Cashier
Raising Canes
08.2014 - 07.2015
- Trained new employees in cashiering procedures and assisted in resolving customer issues.
- Processed customer payments quickly and returned exact change and receipts.
- Trained new team members in cash register operation, stock procedures and customer service.
- Trained new employees in cashiering procedures, offering assistance in resolving [Type] issues.
- Trained new team members in cash register operation and stock procedures.
- Enhanced customer satisfaction by assisting with purchases, locating items, and enrolling in rewards programs.
- Welcomed customers, offering assistance to help find necessary store items.
- Collaborated with managers to design and implement service improvement initiatives.
Education
High School Diploma -
SV Marshall High School
USAssociate of Science - Nursing
Holmes Community College
US, MSSkills
- Dental Claims processing
- Claims analysis project
- Call management
- Customer service excellence
- De-escalation techniquest
- Customer relations
- Customer interaction system
- Call center operations
- Call center experience
- Call controlling
- Inbound phone calls
- Inquiry response
- Documentation
- Documentation skills
- Data entry
- CRM expertise
- Typing proficiency
- Computer skills
- Remote work capabilities
- Problem resolution
- Problem-solving
- Problem-solving skills
- Call management
- Active listening
- Building rapport
- Teamwork and collaboration
- Multitasking Abilities
- Communication skills
- Assisting Call Center Representative with real time adjustments via chat
- Assisting with same day Quality Audits
- Customer assistance
- Customer service excellence
- Training support
- Assisting Call Center Representative with real time adjustments via chat
- Assisting with same day Quality Audits
Accomplishments
I have been apart of two outbound Projects for provider outreach out and a project for the credentialing department.
Languages
English
Timeline
Claims Representative
UnitedHealth Group
10.2025 - Current
Customer Service Advocate
Centene
06.2023 - 10.2025
Call Center Customer Service Representative
Molina Healthcare Inc.
05.2018 - 12.2022
Call Center Customer Service Representative
Conduent
07.2015 - 06.2017
Cashier
Raising Canes
08.2014 - 07.2015
High School Diploma -
SV Marshall High School
Associate of Science - Nursing
Holmes Community College