Twila Lee
Birmingham,AL
Summary
Detection & Investigative Analyst Lead guiding complex claim investigations, settlement decisions, and issue resolution across high-volume caseloads. Applies insurance policy analysis, negotiation, and detailed fact review to settle claims fairly while protecting employer interests. Builds productive partnerships with adjusters, legal counsel, and medical professionals to move cases to timely closure.
Overview
1
1
Certification
27
27
years of professional experience
Work History
Detection & Investigative Analyst Lead
PNC Bank, NA
09.2022 - Current
- Managed high volume of claims by prioritizing tasks and ensuring organized workflow, leading to timely resolutions.
- Enhanced customer satisfaction through timely communication and clear explanations of claim outcomes, fostering trust and transparency.
- Managed a high volume of claims effectively by prioritizing tasks and maintaining excellent organizational skills.
- Settled complex claims by applying critical thinking and negotiation skills, ensuring fair outcomes aligned with insurance policy guidelines.
CSR II
Wells Fargo
01.2016 - 09.2022
- Provide guidance for banker to be successful in Quality Assurance
- Provided customers with financial tools to enhance their financial success
- Experience assessing and meeting the needs of customers
- Assist with online access or troubleshooting when necessary
- Ability to navigate multiple computer screens while working on the phone
- Ability to work effectively in a team environment and across all organizational levels, where flexibility, collaboration, and adaptability are important
- Ability to execute in a fast paced, high demand, environment while balancing multiple priorities
- Strong attention to detail and accuracy skills
- Good verbal, written, and interpersonal communication skills
- Basic Microsoft Office skills
- Intermediate Microsoft Office skills
- Assessed and met customer needs to improve overall satisfaction
- Banking finance experience
- Debit card experience
- Knowledge and understanding of regulatory compliance requirements surrounding Regulation CC or DD
- Knowledge and understanding of financial crime, fraud, or risk management
- Ability to identify potential fraud/risky accounts and take appropriate action to prevent loss
- Ability to make timely and independent judgement decisions while working in a fast-paced and results-driven environment
- Fraud After Hours Specialists
- Identified potential fraud/risky accounts and took action to mitigate losses
- Ability to make timely and independent judgment decisions while working in a fast-paced and results-driven environment
Customer Service Representative
Blue Cross Blue Shield
11.2015 - 01.2016
- Assisted members and physicians in call center by responding to telephone and written inquiries promptly, accurately, and objectively under supervision
- Conducted research and spent approximately 90% of scheduled time on the phone to address business needs
- Provided exceptional customer support via phone and email, resolving inquiries and complaints efficiently.
- Developed comprehensive knowledge of insurance products and services to better assist clients.
- Trained new team members on customer service protocols and software systems, enhancing team performance.
Medical Collector
ARC Management Group
03.2015 - 07.2015
- Provided personalized services to clients, demonstrating commitment to exceptional service quality
- Collected on past due loans, ensuring timely recovery and maintaining client relationships
- Established payment arrangements to prevent collections activity and protect clients' credit scores
- Specialties: First Party Medical, Consumer Collections, Legal Action, Sell Debt, Commercial Collections, Financial Services, Pre-Litigation Legal Collections, Post Judgment Collections, Risk Management Strategy
Account Manager
Green Tree
01.2014 - 12.2014
- Negotiated payment arrangements to enable borrowers to remain in their homes
- Negotiate payment arrangements to keep them in their home
- Managed accounts in 30, 60, and 90 day levels to ensure timely payments and account resolution
- Carval - Car loans 30,60,90 day levels
- I received Collector Of The Month for March
Phone Banker II
Wells Fargo
08.2012 - 01.2014
- Good daily customer service contact by phone to discuss accounting issues
- Analyzed and made proper billing adjustments on customer statements
- Assessed, and reviewed statements for accuracy
- Post and input data against source documents into a financial system
- Keyed and coded payments into billing system
- Provided daily customer service by phone to resolve accounting inquiries and enhance customer satisfaction
- Analyzed customer statements to identify discrepancies and implemented billing adjustments for accuracy
- Review, compare, and balance accounts on a monthly basis
Financial Care Rep II
T-Mobile USA
08.2007 - 07.2012
- Provide customer service by phone to discuss billing issues
- Provided customer service by phone to resolve billing issues
- Analyzed billing statements and made adjustments to ensure accuracy
- Assessed billing statements for accuracy and compliance with company policies
- Keyed and coded payments into billing system
Team Leader
Sitel Corporation
06.1999 - 08.2007
- Facilitated escalations and customer follow-ups to ensure timely resolution of issues
- Conducted a variety of tasks which may include providing representative support, coaching sessions, tracking various record changes, reports discrepancies
- Assisted with related activities such as escalations, customer follow-ups, or similar duties
- Answered questions and provided over the phone technical assistance
- Entered transaction data on system terminal, consulted database to check status of accounts or verify information when necessary
Education
Diploma - Academics
Wenonah high
Birmingham, ALSkills
Customer service
Microsoft Excel
Microsoft Outlook
Call center operations
Written and oral communication
Claims review
Fraud detection
Policy interpretation
Risk assessment
Escalation management
Certification
Driver's License
Timeline
Detection & Investigative Analyst Lead
PNC Bank, NA
09.2022 - Current
CSR II
Wells Fargo
01.2016 - 09.2022
Customer Service Representative
Blue Cross Blue Shield
11.2015 - 01.2016
Medical Collector
ARC Management Group
03.2015 - 07.2015
Account Manager
Green Tree
01.2014 - 12.2014
Phone Banker II
Wells Fargo
08.2012 - 01.2014
Financial Care Rep II
T-Mobile USA
08.2007 - 07.2012
Team Leader
Sitel Corporation
06.1999 - 08.2007
Diploma - Academics
Wenonah high