Shatoria wheeler
Dallas
Summary
Results-driven insurance professional with proven track record in claims management. Known for effectively resolving complicated claims and maintaining high standards of accuracy. Exceptional team collaborator with focus on adapting to changing needs and delivering reliable outcomes. Expertise in risk assessment and customer service.
Developed strong analytical and customer service skills within fast-paced insurance environment. Proficient in evaluating claims, resolving disputes, and maintaining accurate records. Seeking to transition into new field, leveraging these skills to contribute effectively in different professional domain.
Overview
5
5
years of professional experience
Work History
Insurance Specialist
Allstate(CMS)
10.2024 - 11.2024
- Enhanced customer satisfaction by addressing insurance-related inquiries and resolving issues promptly.
- Processed eligibility and benefits verification and authorization requests.
- Worked with claims adjusters and examiners to expedite processing in alignment with procedures.
- Strengthened client relationships by providing clear communication throughout the claims process, ensuring all parties were well-informed of progress and outcomes.
Insurance Claims Specialist
Alacrity Solutions
04.2024 - 10.2024
- Worked with claims adjusters and examiners to expedite processing in alignment with procedures.
- Strengthened client relationships by providing clear communication throughout the claims process, ensuring all parties were well-informed of progress and outcomes.
- Enhanced customer satisfaction by efficiently managing insurance claims processes and providing timely resolutions.
- Maintained compliance with industry regulations and standards by staying current on relevant laws, policies, and best practices for handling insurance claims.
Billing Specialist
SPECTURM
07.2022 - 03.2024
- Provide Billing Support
- Support customers who have questions about their bill, existing services or potential service enhancements and ensure that expectations have been met prior to ending the call
- Work with customers who have accounts that are in past due status to ensure that they understand their options and do not experience any disruption in service
- Listen to customer concerns and diffuse frustration by providing options and solutions
- Ensure Customer Satisfaction internal and external
- Understands customer needs, and strives to meet customer expectations, ensuring great customer service
- Receive and respond to high volume of telephone inquiries from internal and/or external customers and provide expert advice and solutions through problem resolution
- Provide all pertinent information to the customer and document it using the appropriate call-tracking system to ensure first contact resolution
- Develop and maintain strong product and customer knowledge base on a continuous basis via internal training opportunities, external sources and self-education
Insurance Specialist
STATE FARM (CMS)
08.2020 - 07.2022
- Assisted policy holders on making claims for catastrophe due to any storm that affected their homes
- Assisted policy holders with regular claims for damages done to properties
- Created auto drive-ins for adjusters to inspect auto/home damages
- Resolved various conflicts while utilizing strong communication skills, maintaining respect, and professionalism
- Communicated and collaborated with team members and business
- Applied knowledge of policies, procedures, laws, statutes, and insurance regulations when determining coverage, liability, and damages
- Enhanced customer satisfaction by addressing insurance-related inquiries and resolving issues promptly.
- Processed eligibility and benefits verification and authorization requests.
Insurance Data Specialist
DENTAL ONE PARTNERS
12.2019 - 06.2020
- Engaged in research setup, preparation, and execution of new or existing fee schedules
- Maintained accuracy and integrity of data
- Communicated with payers
- Verified plan setup and estimations of dental claims
- Maintained productivity logs
- Appropriately made request for documentation based on account needs and compliance guidelines
- Built and attached insurances to patients and billed them to payers (temporary part-time assignment)
Education
Graduate -
Lakeview High School
Garland, TX01.2009
Skills
- Claims investigation
- Claims analysis
- Policy interpretation
- Teamwork and collaboration
- Attention to detail
- Customer service
- Claims processing
- Active listening
- Data entry
- Insurance coverage verification
- Documentation skills
Timeline
Insurance Specialist
Allstate(CMS)
10.2024 - 11.2024
Insurance Claims Specialist
Alacrity Solutions
04.2024 - 10.2024
Billing Specialist
SPECTURM
07.2022 - 03.2024
Insurance Specialist
STATE FARM (CMS)
08.2020 - 07.2022
Insurance Data Specialist
DENTAL ONE PARTNERS
12.2019 - 06.2020
Graduate -
Lakeview High School
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