YVONNE M. MCGRIFF
Knoxville,TN
Summary
Professional with proven track record in administrative support and operations management, ready to excel in back office or front office customer service functions. Skilled in data management, and problem-solving. Strong focus on team collaboration and achieving results, adaptable to changing needs, and reliable for ensuring smooth workflow. Known for attention to detail, effective communication, and organizational skills essential for this role.
Overview
18
18
years of professional experience
Work History
Back Office Adjudication/Fraud Review
Accenture Inc
Knoxville
10.2021 - Current
- Conducting security adjudicative administrative processes, analytic, and risk mitigation.
- Evaluating reports of investigations, interpreting, and applying adjudicative guidelines to formulate a recommended course of action.
- Reviewing case files of all relevant materials pertaining to a case including all paperwork, any other source materials, and the opinions of other relevant/investigative personnel.
- Reviewing investigative documents to identify discrepancies, inconsistencies, and areas potentially requiring clarification or additional investigation.
- Determining if additional inquiries are necessary to resolve discrepant, negative, or contradictory information.
- Reviewing and verifying information submitted on applications/Personnel Security Questionnaires
Customer Service Representative
Accenture Inc
Knoxville
04.2021 - 10.2021
- Assist the claimant in processing unemployment claims due to the increased demands in claims due to Covid-19.
- Provided Front Office responsibilities: Assisted residents of the state of Maryland with filing unemployment claims, assisted claimants in problems solving system issues along with completing weekly certifications and fast-forwarding issue to the correct team.
- Assisting the claimant in applying for the correct program and trained to research and verify fraudulent claims.
Claims Adjuster (Converted to Accenture Flex)
Accenture Inc
Louisville, TN
11.2018 - 04.2021
- Analytical problem-solving skills with experience in applying these skills to complex problem-solving solutions.
- Ability to establish and maintain quality, accountability, productivity.
- Ability to establish and maintain effective working relationships with other team members.
- Exceptional written and verbal communication skills
- Ability to multitask and close inquiries fast and efficiently.
- Proven ability to analyze, research and resolve problems in a timely manner.
- Ability to work under pressure and to meet deadlines
- Possess the ability to work independently and as a team.
- Ability to grow and successfully complete each upscale within different projects and clients.
Claims Adjuster
Vdart Inc
Alpharetta, United States
11.2015 - 11.2018
- Examined claims forms and other records to determine insurance coverage.
- Maintained compliance with state regulatory requirements through meticulous documentation and adherence to company policies.
- Reviewed police reports, medical treatment records.
- Attended industry trainings to stay current on trends and developments within the field of claims adjusting.
- Evaluated coverage accurately by interpreting complex insurance policies and applying them to specific claim scenarios.
- Improved claim resolution times by efficiently managing a caseload of 50+ claims per month.
- Provided exceptional customer service, addressing concerns, and answering questions promptly.
Customer Care Representative/Externship
Hanger Clinic Inc
Knoxville, Tennessee
08.2014 - 08.2014
- Check Patients in
- Verified Patients Insurance Coverage
- Scheduled Patient Appointments
- Other General Office Duties
Loss Prevention Specialist
CVS Caremark Distribution Center
Knoxville, Tennessee
05.2007 - 05.2013
- In charge of daily, weekly, monthly, quarterly, and yearly audits of the distribution center's safety program.
- Oversaw a staff of quality operators and made sure product was being shipped to the stores correctly and made sure the product was not damaged.
- Performed Mock Audits also reviewed and updated SOP's.
Education
Diploma - Medical Billing and Coding, Medical Insurance
Virginia College
Knoxville, TN07.2014
Skills
- Data entry expertise
- Critical thinking
- Claims investigation
- CCTV systems
- Highly motivated
- Incident reporting
- Customer relations
- Claims processing
- Policy enforcement
- Workflow coordination
- Investigations
- Call center experience
- Audit procedures
Timeline
Back Office Adjudication/Fraud Review
Accenture Inc
10.2021 - Current
Customer Service Representative
Accenture Inc
04.2021 - 10.2021
Claims Adjuster (Converted to Accenture Flex)
Accenture Inc
11.2018 - 04.2021
Claims Adjuster
Vdart Inc
11.2015 - 11.2018
Customer Care Representative/Externship
Hanger Clinic Inc
08.2014 - 08.2014
Loss Prevention Specialist
CVS Caremark Distribution Center
05.2007 - 05.2013
Diploma - Medical Billing and Coding, Medical Insurance
Virginia College