Tawyona Jones
Dallas,TX
Summary
Proactive, friendly customer service specialist, with a background in Fraud as well as insurance sales and claims, dedicated to meeting and exceeding expectations at every interaction. Timely and professional with extraordinary communication skills and the ability to build and cultivate relationships to drive business retention. Actively seeking a Claims Adjuster role where I can utilize my education and experience to add immediate value to an organization.
Overview
10
10
years of professional experience
Work History
Medical Scheduler
Lumexa
Lewisville, TX
01.2025 - Current
- Managed appointment scheduling for diverse medical specialties, optimizing provider availability.
- Coordinated patient communications, ensuring timely notifications and reducing no-show
- Answered telephone calls to offer office information, answer questions, and direct calls to staff.
- Managed cancellations or no-shows efficiently, proactively filling open slots with patients from waitlists or urgent care needs.
- Followed up with patients to reschedule missed appointments.
Claims Adjuster
Root Insurance
04.2024 - 10.2024
- Complete initial reviews on Auto Claims i.e. photos of the damages, time and date of loss, police report, initial loss description. Interview all involved parties to get descriptions of the scene of the accident and discrepancies in the story. Determine liability at either 100% liability or 50/50. Setup and work closely with Copart to determine total loss of property. Highly experience in time and desktop management
Fraud Analyst/Collections
Genpact
03.2021 - 04.2024
- Assert disputes for authorized and unauthorized transactions. Work account restriction case for Account Takeover and first-party fraud. Process Loan Applications that have been flagged as fraudulent by verifying the customer’s identity via LexisNexis. Maintained a Customer Satisfaction and a Quality Assurance score of 85% and above. Review paystubs/Bank Statements for income verification Inspect authenticity of checks, Direct Deposit slips for bank verification Inbound and outbound call experience Assist customer with hardship enrollment programs Communicate with customers how to prevent credit bureau reporting by negotiating possible payment options.
Fraud Specialist
Advanced Call Center
09.2020 - 03.2021
- Establish relationships with customers for assistance with problems they may encounter. Issue receipts, refunds, credits, or change due to customers. Assist customers by providing information and resolving their complaints. Filing Fraud/Non Fraud claims
Customer Service Representative
AXS Ticketing
04.2019 - 05.2020
- Suggest and check alternate spellings, locations, and/or listing formats to customers lacking details or complete information. Update directory information. Check to ensure that appropriate changes were made to resolve customers’ problems. Solicit sales of new or additional services or products. Exceeded long term metrics goals in a short period of time 95% adherence, with a 95% in Quality Assurance, and an 85% for my Handle time.
Member Services Associate
Sam’s Club
08.2018 - 08.2019
- Accepted and processed customer payments in cash, credit cards and checks, checking for validity. Acknowledged customer issues and resolved their problems quickly and efficiently. Effectively communicate with other employees and upper management to ensure complete care of customers. Adhered to all store retail procedures and policies. Interfaced with customers to determine purchasing needs, directed them to appropriate items, and recommended additional products.
Licensed Sales Agent
National General Insurance
06.2016 - 06.2018
- Explain features, advantages and disadvantages of various policies to promote sale of insurance plans. Calculate premiums and establish payment method. Perform administrative tasks, such as maintaining records and handling policy renewals.
Education
High School - undefined
Plano West High School
01.2013
Skills
- CSR
- Exceptional listening skills
- Data entry
- Scheduling
- Communication skills
- Windows
- Call Center
- Multi-tasking and negotiation
- Customer Service
- Live chat
- Negotiation
- Ability to build and foster relationships
- Medical billing and coding
- Banking
- Clerical Experience
- Detail oriented
- Cold calling
- Insurance sale
Timeline
Medical Scheduler
Lumexa
01.2025 - Current
Claims Adjuster
Root Insurance
04.2024 - 10.2024
Fraud Analyst/Collections
Genpact
03.2021 - 04.2024
Fraud Specialist
Advanced Call Center
09.2020 - 03.2021
Customer Service Representative
AXS Ticketing
04.2019 - 05.2020
Member Services Associate
Sam’s Club
08.2018 - 08.2019
Licensed Sales Agent
National General Insurance
06.2016 - 06.2018
High School - undefined
Plano West High School