Tiara Malette
Charlotte,NC
Summary
Dedicated and results-driven Claims Agent with 6 years of experience managing and processing a variety of claims in a remote setting. Proven expertise in assessing claims for accuracy, investigating discrepancies, and ensuring compliance with industry standards and regulations. Skilled at handling complex customer inquiries, negotiating settlements, and providing exceptional customer service. Known for resolving claims efficiently while maintaining meticulous records and consistently meeting performance goals.
Overview
8
8
years of professional experience
Work History
Senior Claims Specialist
Blue Cross Blue Shield
11.2021 - 02.2026
- Handled large and complex claims methodically to determine liability conclusively and ensure accurate settlements.
- Worked cooperatively with claimants, legal teams, and adjusters to gather required information and documentation, resulting in quicker claims turnaround.
- Identified and referred suspected fraud cases, drastically reducing fraudulent claim payments.
- Increased team performance by training and mentoring junior claims agents to work more efficiently and effectively.
- Introduced new methods to address key needs, resulting in faster claim disbursal and increased customer satisfaction and trust.
Claims Specialist
Wells Fargo
01.2019 - 05.2021
- Processed claims to determine coverage, liability, and damages, making recommendations for settlements in accordance with policy provisions.
- Collaborated with cross-functional teams (Legal, Underwriting, Customer Service) to resolve claims issues and ensure compliance with company policies.
- Collected insights to implement process enhancements in claims processing, improving overall efficiency.
- Generated detailed ad hoc reports on claim outcomes, trends, and recommendations to management for operational improvements.
- Handled high-volume claims processing with extreme accuracy and attention to detail.
Claims Processor
PRA Group
01.2018 - 12.2018
- Completed and verified insurance claims, ensuring all required documents were prepared for submission and processing.
- Verified coverage details and claim validity; followed up with claimants when information was incomplete or unclear.
- Provided customers with accurate, professional updates on claim status, explaining coverage, follow-up procedures, and expected processing timelines.
- Recorded all claims activities in compliance with internal procedures and external regulations.
- Assisted senior claims specialists by handling lower-complexity claims to expedite team resolutions.
Education
MBA -
University of North Carolina Pembroke
08.2021
High School Diploma -
LakeLand
06.2013
Skills
- Insurance Claim Forms Review
- Microsoft Office
- Process Optimization
- Fraud Detection
- Claims Investigation
- Estimate Preparation
- Settlement Determinations
- Claim Amount Calculations
- Regulatory Compliance
- Customer Service
- Small Claims Payouts
- Settlement Negotiation
- Data Entry
- TW/Collab Tools
Timeline
Senior Claims Specialist
Blue Cross Blue Shield
11.2021 - 02.2026
Claims Specialist
Wells Fargo
01.2019 - 05.2021
Claims Processor
PRA Group
01.2018 - 12.2018
High School Diploma -
LakeLand
MBA -
University of North Carolina Pembroke