TIERNI GAUNA
Sharpsburg,GA
Summary
Detail-oriented and highly organized Customer Service and Claims Specialist with over [3] years of experience in managing customer inquiries, resolving claims, and delivering exceptional service across diverse industries. Expert at building relationships with clients, handling complex claims processes, and ensuring compliance with company policies and regulations. Adept at using CRM systems and working in fast-paced, high-pressure environments to meet performance goals and improve client satisfaction. Dedicated to maintaining a high standard of service while driving operational efficiency and profitability for the company.
Overview
2
2
years of professional experience
1
1
Certification
Work History
Claims Specialist
Abc Financial services
Atlanta, GA
06.2023 - 07.2024
- Managed a portfolio of customer accounts, processing claims, handling billing inquiries, and addressing policyholder concerns across various insurance lines, including health, auto, and property.
- Reviewed and validated claims, ensuring all documentation was complete and accurate, minimizing the risk of fraud or processing delays.
- Resolved complex billing and coverage issues, negotiating with clients and third-party vendors to reach mutually beneficial outcomes.
- Processed an average of [10] claims per day, consistently meeting or exceeding productivity and quality benchmarks.
- Provided detailed claim status updates and solutions to clients, which resulted in a 10% increase in customer retention.
- Collaborated with the fraud detection team to identify suspicious claims, saving the company over $[1M] annually in potential fraudulent payouts.
Security Officer
Allied Universal Security
Atlanta, GA
12.2022 - 04.2023
- Checked for safety hazards and took corrective action when necessary.
- Monitored surveillance cameras and responded to suspicious activity.
- Conducted regular security patrols of the facility grounds, parking lots, and perimeter areas.
- Investigated all reported incidents of theft or vandalism on premises.
- Enforced access control measures in accordance with established procedures.
- Responded to alarms and conducted investigations as required.
Customer Service Representative
William Sonoma
Remote, GA
02.2022 - 10.2022
- Delivered top-tier customer service by responding to client inquiries through phone, email, and live chat support, maintaining a [70]% first-call resolution rate.
- Handled escalated customer complaints regarding product issues, returns, and warranties, ensuring customer concerns were addressed quickly and satisfactorily.
- Assisted customers with billing and account-related issues, helping to streamline payment processes and prevent service disruptions.
- Promoted to a supervisory role within the first year, responsible for mentoring new team members and handling high-priority customer cases.
Education
Associate of Arts - Business Management
West Georgia Technical College
Newnan, GA06-2024
Skills
- Claims Processing & Investigation
- Customer Relationship Management (CRM)
- Problem Solving & Conflict Resolution
- Insurance & Claims Policies Knowledge
- Compliance & Regulatory Guidelines
- Call Center & Multi-Channel Support
- Claims Adjudication
- Data Analysis & Reporting
- Team Leadership & Training
- Communication & Negotiation Skills
- Process Improvement & Workflow Optimization
- Time Management & Multitasking
- CRM Systems: Salesforce, Zendesk, Freshdesk
- Claims Management Software: Guidewire, ClaimVantage
- Microsoft Office Suite (Word, Excel, PowerPoint, Outlook)
- Data Analysis & Reporting Tools (Tableau, Google Analytics)
Languages
English
Professional
Certification
- Certified Claims Adjuster (CCA) | 2024
References
References available upon request.
Timeline
Claims Specialist
Abc Financial services
06.2023 - 07.2024
Security Officer
Allied Universal Security
12.2022 - 04.2023
Customer Service Representative
William Sonoma
02.2022 - 10.2022
Associate of Arts - Business Management
West Georgia Technical College
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