Veola Johnson
Houston,TX
Summary
Experienced Insurance Claims Specialist with over 5 years in analyzing and resolving diverse claims. Expertise in interpreting policy language and medical terminology while applying regulatory guidelines. Collaborates effectively with claimants and teams to achieve fair outcomes and has a track record of improving claim processing efficiency.
Overview
3
3
years of post-secondary education
5
5
years of professional experience
Work History
Customer service Professional II
Illumifin
, Indiana
03.2023 - 05.2026
- Documented new and existing long term care insurance claim details in eLTCAS to ensure accurate record-keeping.
- Applied problem-solving skills to de-escalate customer complaints effectively, regarding deductibles, benefit maximum, daily and monthly allowances and reimbursements.
- Reduced average claim processing time by 20% through refined workflows and proactive claimant follow-up.
- Investigated claim details by reviewing updates on claims benefits and eligibility processing.
- Collaborated with departments to efficiently update client information.
Insurance Claims Specialist
People Scott
06.2022 - 04.2023
- Negotiated settlements with claimants, and third-party service providers, consistently adhering to fair claim practices.
- Leveraged CRM systems, SharePoint, and Microsoft Word to track documents and report on claim status, enhancing data accuracy.
- Continuously exceeded metrics 95% displayed empathy when warranted on customer calls.
- Collaborated with team members to resolve complex claims issues, improving overall claims processing efficiency.
- Adhered to strict guidelines pertaining to confidentiality while handling sensitive customer personal information.
Claims Examiner II
American International Group Inc
11.2020 - 12.2021
- Cross-trained on three clients, processed manufactured appliances claims via email and phone support.
- Evaluated claims accurately, providing polite empathetic customer service.
- Determined appliance eligibility in snap system and excel for repaired, replaced, buyout accuracy.
- Evaluated claims, delivering accurate results while providing empathetic customer service.
- Managed 40 accounts to completion. Exceeded exceeded the 25 daily task expectations.
- Remained in top 94% metrics adherence.
- ACW = AFTER CALL WORK
Education
Associate of Arts - Business Administration, Communications
American InterContinental University
Schaumburg, IL 01.2017 - 12.2019
Skills
- Claims management
- Claims negotiation
- Insurance verification
- Documentation
- CRM Software
- Customer Service Tools
- Office productivity tools
- Remote work in call centers
- Medical Terminology
- Communication skills
Accomplishments
- Awarded 'Top Performer' for consistently achieving a 95% on-time resolution rate and outstanding policyholder satisfaction feedback.
- Implemented a streamlined evidence-gathering process, reducing claims review times by 30%.
- Recognized for effectively cutting fraudulent payouts by 20% through proactive fraud detection and thorough investigations.
Software Technical Skills
- Claims Management Systems (Guidewire, ClaimCenter)
- Estimation Tools ( Xactimate)
- Microsoft Office Suite & Google Workspace
- CRM Platforms
- Customer Service Tools (Salesforce)
Timeline
Customer service Professional II
Illumifin
03.2023 - 05.2026
Insurance Claims Specialist
People Scott
06.2022 - 04.2023
Claims Examiner II
American International Group Inc
11.2020 - 12.2021
Associate of Arts - Business Administration, Communications
American InterContinental University
01.2017 - 12.2019