Shena Similien
Miramar,FL
Summary
Highly-motivated employee with desire to take on new challenges. Strong work ethic, adaptability, and exceptional interpersonal skills. Able to work effectively and consistently deliver high-quality results.
Overview
9
9
years of professional experience
Work History
Independent Contractor
AMERIHEALTH PROVIDER SUPPORT
Miramar, FL
01.2024 - Current
- Develop relationships with new providers by providing guidance on how to use our systems, processes, and policies.
- Verify benefits, eligibility, and prior authorization requests.
- Adhere to all applicable laws, regulations, standards, and procedures when interacting with customers and providers.
- Verifies accuracy of submitted documentation prior to processing claims or services rendered.
- Verifies accuracy of submitted documentation prior to processing claims or services rendered.
- Process claims and coordinate with providers, payers, and other third parties, as necessary.
- Maintain detailed records of client communications in the company's database system.
- Performs data entry tasks including entering patient information into electronic medical records systems.
- Responds promptly to calls from by providers' regarding billing inquiries or other related matters.
Virtual Customer Service Representative
CHEWY
Hollywood, FL
09.2022 - 01.2024
- Assisted customers with product returns and exchanges.
- Maintained up-to-date knowledge of company products and services.
- Answered incoming calls from customers seeking assistance with product information or orders.
- Followed up on existing accounts to ensure satisfactory resolution of any outstanding inquiries.
- Adjusted bills and refunded money to resolve customers' service or billing complaints.
- Presented existing and prospective customers with valuable service or product information to aid in decision-making.
- Strengthened customer retention by offering discount options.
Debit Card Claims/Sr Claims Operations Specialist
WELLS FARGO BANK N.A
Pompano Beach, USA
10.2015 - 08.2022
- Reviewed and processed incoming claims for accuracy, completeness, and compliance with established procedures.
- Reviewed customer accounts for suspicious activity and fraudulent transactions.
- Collaborated with other departments to ensure proper resolution of fraud claims.
- Monitored customer account activities for potential money laundering activities or other suspicious behavior.
- Responded promptly to customer inquiries regarding fraudulent activity on their accounts.
- Recommended changes in security protocols based on findings from investigations.
- Made recommendations for closing accounts and performed associated follow-up.
- Investigated debit card fraud cases, identified patterns and trends in fraudulent activities.
- Reported incidents of debit card fraud to financial institutions, law enforcement agencies and other relevant organizations.
- Responded promptly to customer inquiries regarding suspected or confirmed debit card fraud incidents.
- Reviewed, verified and identified customer transactions to detect and prevent financial crimes activities.
Education
HIGH SCHOOL DIPLOMA -
AMERICAN ACADEMY
Associate in Arts -
Broward College
Skills
- Customer Relations
- Critical Thinking
- Account Management
- Problem-solving abilities
- Adaptive team player
- Microsoft PowerPoint
- Customer Relationship Management (CRM)
- Computer Proficiency
References
Available upon request
Timeline
Independent Contractor
AMERIHEALTH PROVIDER SUPPORT
01.2024 - Current
Virtual Customer Service Representative
CHEWY
09.2022 - 01.2024
Debit Card Claims/Sr Claims Operations Specialist
WELLS FARGO BANK N.A
10.2015 - 08.2022
HIGH SCHOOL DIPLOMA -
AMERICAN ACADEMY
Associate in Arts -
Broward College
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