Terence Calhoun
Spring,TX
Summary
Analytical Claims Examiner known for high productivity and efficient task completion. Possess specialized skills in claim investigation, policy interpretation, and dispute resolution. Excel at communication, problem-solving, and decision-making to facilitate fair and timely claim settlements.
Overview
8
8
years of professional experience
Work History
Claims Examiner
Medical Mutual Of Ohio And Its Family Of Companies
Oklahoma Ci, OK
08.2020 - Current
- Performed data entry into the computer system to record information regarding claim status.
- Collaborated with internal departments such as Underwriting, Provider Relations, Medical Management, and Quality Assurance, as needed.
- Managed workloads efficiently by prioritizing tasks based on urgency or importance.
- Developed a detailed understanding of the company's policies and procedures related to claim processing and payment determination.
- Interpreted policy terms and conditions to ascertain claim eligibility.
- Documented claim actions and decisions thoroughly for audit purposes.
- Handled and processed variety of claims.
Customer Service Representative
Reserve National Insurance
Oklahoma City, OK
06.2019 - 08.2020
- Resolved customer complaints promptly and efficiently.
- Answered customer inquiries and provided accurate information regarding products and services.
- Maintained a high level of professionalism when dealing with difficult customers.
- Provided exceptional customer service to ensure customer satisfaction.
- Maintained detailed records of customer interactions, transactions and comments for future reference.
- Resolved complex problems by working with other departments to provide solutions that meet customer needs.
General Clerk II
Serco Group
Lawton, OK
11.2016 - 06.2019
- Assisted with data entry, filing, sorting mail, and other office duties.
- Inputted data into the company's database system.
- Organized documents according to established procedures.
- Resolved customer inquiries in a timely manner.
- Responded promptly to customer inquiries via phone or email.
- Answered incoming calls in a professional manner.
- Managed customer inquiries and complaints in a professional manner.
Education
High School Diploma -
The Woodlands High School
The Woodlands, TX05-1997
Skills
- Microsoft Office Suite
- Verbal Communication
- Insurance knowledge
- Claims Processing
- Active Listening
- Policy Interpretation
- Team Collaboration
- Critical Thinking
- Decision-Making
- Teamwork and Collaboration
- Attention to Detail
- Multitasking
- Organizational Skills
- Customer service and support
- Excellent Communication
- Adaptability
Timeline
Claims Examiner
Medical Mutual Of Ohio And Its Family Of Companies
08.2020 - Current
Customer Service Representative
Reserve National Insurance
06.2019 - 08.2020
General Clerk II
Serco Group
11.2016 - 06.2019
High School Diploma -
The Woodlands High School
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