Summary
Overview
Work History
Education
Skills
Timeline
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TAWANA CLAY

Albany,Georgia

Summary

Professional in conflict resolution, skilled in identifying and addressing complex customer issues with precision and empathy. Adept at fostering team collaboration, ensuring seamless communication, and adapting to evolving challenges. Expertise includes problem-solving, critical thinking, and maintaining high service standards to drive successful outcomes. Known for reliability and unwavering focus on achieving goals.

Overview

12
12
years of professional experience

Work History

Senior Resolution Specialist

Wal-Mart Health & Wellness
04.2023 - Current
  • Provided exceptional customer service while managing a high volume of inquiries from clients regarding disputes or complaints.
  • Negotiated settlements between disputing parties, balancing the needs of both sides while upholding company policies.
  • Supported departmental goals by consistently meeting or exceeding performance metrics related to resolutions handled and issue closure rates.
  • Maintained detailed records of all resolutions, ensuring accuracy and compliance with regulatory requirements.
  • Improved customer satisfaction by efficiently resolving complex issues and providing timely solutions.

Claims Resolution Specialist

Assurant
06.2022 - 04.2023
  • Contributed to team success by consistently meeting or exceeding individual performance metrics for claim resolution.
  • Collaborated with various departments for comprehensive claim evaluations, improving overall outcomes.
  • Achieved high customer satisfaction ratings by providing prompt, empathetic, and accurate resolutions to claims.
  • Enhanced claims processing efficiency by streamlining workflows and implementing time-saving procedures.
  • Reduced claim resolution times with thorough investigation and effective communication among involved parties.
  • Identified fraudulent claims through careful analysis of data, protecting company assets from potential losses.
  • Processed adjustments and posted refunds.
  • Ensured compliance with industry regulations and company policies by staying up-to-date on relevant guidelines.

Data Entry Clerk

Alorica Inc.
05.2020 - 02.2022
  • Entered customer and account data from source documents within time limits.
  • Compiled, verified accuracy, and sorted information to prepare source data for computer entry.
  • Review data for deficiencies or errors, correcting any incompatibilities and checking output.

Technical Support Advisor

Teleperformance
08.2016 - 04.2020
  • Keep a record of common problems and their solutions, which can be used as a reference for future troubleshooting.
  • Setting up new user accounts, resetting passwords, or managing user permissions.
  • Maintained expert-level knowledge of company products to provide accurate information to clients during support calls or emails.
  • Maintained confidentiality when dealing with sensitive customer data, adhering strictly to company policies regarding privacy protection.
  • Collaborated with cross-functional teams to identify recurring technical issues, resulting in improved product quality.

Care Claim Specialist

One Call
06.2013 - 05.2016
  • Coordinated and scheduled 50+ patient appointments daily, ensuring compliance with pre and post-exam protocols.
  • Maintained accurate patient records in EMR systems, contributing to a 20% reduction in scheduling errors.
  • Conducted pre-authorization processes with insurance providers, improving approval turnaround by 15%.
  • Delivered high-quality customer service by addressing patient inquiries and resolving conflicts properly.
  • Demonstrated expertise in using Epic for appointment scheduling and patient data management.
  • Reviewed and maintained accurate claim files, ensuring all necessary documentation was in place for future reference.
  • Maintained compliance with industry regulations by staying up-to-date on changes in policies and procedures, ensuring proper handling of sensitive information.

Education

MBA - Human Resources

Ashford University
San Diego, CA

Skills

  • Superior administration abilities
  • Strong clerical and office management skills
  • 3 years MS Office Suite (Word, Excel, PowerPoint, Visio, etc)
  • 10 years of remote experience and customer service

Timeline

Senior Resolution Specialist

Wal-Mart Health & Wellness
04.2023 - Current

Claims Resolution Specialist

Assurant
06.2022 - 04.2023

Data Entry Clerk

Alorica Inc.
05.2020 - 02.2022

Technical Support Advisor

Teleperformance
08.2016 - 04.2020

Care Claim Specialist

One Call
06.2013 - 05.2016

MBA - Human Resources

Ashford University

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TAWANA CLAY