Shelton Floyd
Lutz,FL
Summary
Service-focused professional bringing unparalleled skills in customer relations, task prioritization and time management. Motivated to maintain customer satisfaction and contribute to company success. Specialize in quality, speed and process optimization. Dedicated to directly and efficiently address customer concerns head-on, develop proactive solutions and implement corrections with efficiency. Consummate Claims Associate knowledgeable in MEDICAL insurance coverage, policy terms and conditions. Facilitates claims processing by cultivating productive relationships with stakeholders. Blends analytical and administrative acumen throughout investigations and recommendations.
Overview
16
16
years of professional experience
Work History
Claims Processing
Leading Edge Administrators
02.2021 - 02.2024
- Processed medical claims from self-funded Erisa plans.
- Paid or denied medical claims based upon established claims processing criteria.
- Monitored claims processing trends to identify potential areas of improvement.
- Managed workload and priorities to meet claims processing meet deadlines.
- Complied with regulations and guidelines related to claims processing to maintain quality and adherence to standards.
- Researched issues related to claims processing to identify origins and implement corrective solutions.
Medicare Customer Service Representative
Maximus Federal Services
02.2017 - 02.2021
- Facilitated timely issue resolution, coordinating with diverse departments and healthcare providers as needed.
- Enhanced customer satisfaction by efficiently addressing and resolving Medicare-related inquiries.
- Streamlined claim processing for quicker reimbursements, diligently reviewing submitted documentation.
- Provided exceptional support to Medicare beneficiaries, guiding them through coverage options and plan details.
- Improved call center performance by consistently maintaining a high level of professionalism and productivity.
- Educated customers on preventative care measures, promoting overall health and wellness among beneficiaries.
Lead Member Service Representative/HSA MEMBER SRVC
JPMorgan Chase -
06.2013 - 01.2017
- Enhanced member satisfaction by addressing and resolving complex account inquiries promptly and professionally.
- Streamlined service processes for improved efficiency, resulting in shorter wait times and higher member retention.
- Coordinated with other departments to ensure timely resolution of escalated member issues, leading to a positive impact on overall customer experience.
- Provided comprehensive training and mentoring to new team members, fostering a supportive work environment conducive to professional growth.
Customer Service Supervisor
Verizon Inc
12.2007 - 04.2011
- Improved customer satisfaction by addressing and resolving escalated issues promptly and professionally.
- Enhanced team productivity through regular coaching, feedback, and performance evaluations.
- Streamlined workflow processes for increased efficiency in handling customer inquiries and complaints.
- Collaborated with other departments to address recurring customer concerns, improving overall service quality.
- Developed comprehensive training materials for new hires, ensuring consistent knowledge and skill development across the team.
Education
High School Diploma -
King High School
Tampa, FLSkills
- Team Lead
- Claims Processing
- Attention to Detail
- Microsoft Office Suite efficient
- Customer service
- Performance metrics
- Call center operations
- Verbal and written communication
- Customer Relationship Management
- Complaint resolution
- Quality assurance
- Logging call information
- Sales expertise
- Inbound and Outbound Calling
- First call resolution
- Multitasker
- Team Building
- Claims Processing Knowledge
- Claims Processing Familiarity
References
Available Upon Request
Certification
Timeline
Claims Processing
Leading Edge Administrators
02.2021 - 02.2024
Medicare Customer Service Representative
Maximus Federal Services
02.2017 - 02.2021
Lead Member Service Representative/HSA MEMBER SRVC
JPMorgan Chase -
06.2013 - 01.2017
Customer Service Supervisor
Verizon Inc
12.2007 - 04.2011
High School Diploma -
King High School
Similar Profiles
Deborah HarrellDeborah Harrell
CLAIMS QUALITY ASSURANCE MANAGER at Valuehealth Benefit AdministratorsCLAIMS QUALITY ASSURANCE MANAGER at Valuehealth Benefit Administrators
CRANEISHA CARMICHAEL TUTENCRANEISHA CARMICHAEL TUTEN
LEADING at EDGE ADMINISTRATORSLEADING at EDGE ADMINISTRATORS
Marcus DawangMarcus Dawang
CNC Machine Operator at Leading Edge Machine SolutionsCNC Machine Operator at Leading Edge Machine Solutions