Tiona Miller
Hahira,GA
Summary
Dynamic Fraud Detection Specialist with a proven track record at Concentrix, enhancing fraud detection rates through advanced data analysis. Skilled in customer service and payment collection, I effectively resolved fraud-related concerns, improving customer satisfaction. Committed to continuous professional development, I proactively identified and mitigated emerging threats in financial crimes.
Diligent efforts with solid background in customer service. Proven track record of efficiently resolving customer inquiries and maintaining high satisfaction rates. Demonstrated ability to leverage communication and problem-solving skills to enhance customer experience.
Overview
5
5
years of professional experience
Work History
Fraud Detection Specialist
Concentrix
Valdosta, GA
01.2024 - Current
- Recommended improvements to current fraud monitoring systems, resulting in increased efficiency and effectiveness.
- Maintained comprehensive records of all investigations conducted, supporting future audits or regulatory inquiries as needed.
- Supported the development of a company-wide fraud risk assessment framework, enabling proactive identification and mitigation of emerging threats.
- Improved customer satisfaction through timely communication and resolution of fraud-related concerns.
- Stayed up-to-date with emerging trends in financial crimes by attending professional development courses and workshops regularly.
- Enhanced fraud detection rates by implementing advanced data analysis techniques and tools.
Claims Resolution Specialist
Sedgwick Claims Management
Remote, Ga
04.2023 - 12.2024
- Maintained detailed case records using specialized software programs for easy reference during future audits or reviews.
- Investigated issues to determine appropriate coverage and liability for Type claims.
- Acted as a liaison between adjusters, legal teams, and other professionals involved in the resolution process.
- Collected information about rejected claims and developed effective solutions.
- Explained policy coverage, liability and denials to policyholders, lawyers, and other involved parties.
Healthcare Customer Service Representative
Conduent
Remote, Ga
09.2022 - 03.2023
- Ensured compliance with HIPAA regulations when handling sensitive patient information, protecting client privacy at all times.
- Enhanced patient satisfaction by efficiently addressing and resolving healthcare-related inquiries.
- Managed difficult conversations with compassion and professionalism, helping deescalate tense situations while maintaining a focus on finding resolutions.
- Increased first-call resolution rates by carefully listening to customers'' needs and providing accurate information based on their inquiries.
Patient Billing Representative
Humana
Remote, Ga
05.2020 - 08.2022
- Streamlined the billing process for increased efficiency by implementing electronic filing systems and automating routine tasks.
- Established positive relationships with insurance company representatives, facilitating effective communication during the claim resolution process.
- Managed sensitive patient data securely, adhering to HIPAA guidelines and maintaining strict confidentiality at all times.
- Optimized cash flow by establishing payment plans for patients with high deductible insurance plans or significant out-of-pocket expenses.
Education
Bachelor Of Health Science -
Valdosta State University
Valdosta, GA2026
Lowndes High School
Valdosta05.2020
Skills
- Customer service
- Payment collection
- Scheduling appointments
- Medical terminology
- Eligibility determination
- Document filing
- Data entry proficiency
Timeline
Fraud Detection Specialist
Concentrix
01.2024 - Current
Claims Resolution Specialist
Sedgwick Claims Management
04.2023 - 12.2024
Healthcare Customer Service Representative
Conduent
09.2022 - 03.2023
Patient Billing Representative
Humana
05.2020 - 08.2022
Bachelor Of Health Science -
Valdosta State University
Lowndes High School