SUMMARY

Shilique has *+ years of customer service experience and 3 years of administrative experience. She is experienced in addressing customer inquiries and resolving problems. She is skilled in utilizing Microsoft products such as Excel and Word, office equipment and various computer programs. Due to her background in insurance fraud and claims, she is skilled at working with details such as numbers and names. Shilique is experienced in exercising active listening and problem-solving skills to resolve complex situations. Additionally, she has a good work ethic, interpersonal skills, multitasking skills, and organizational skills.

SKILLS

•Data Entry

•Insurance Fraud Expertise

• Property Claims

• Property Adjusting

•Customer Service

•Verbal and Written Communication

•Documentation and Reporting

PROFESSIONAL EXPERIENCE

VIRTUAL CLAIMS PROCESSOR

Maximus Call Center Petersburg, VA January 2021 – August 2023

•Reviewed historical records to determine benefit eligibility for services.

•Processed claims according to established quality and production standards and made corrections and adjustments to solve problems.

•Addressed customer inquiries to provide information and explanations on coverage and terms, expediting claims.

•Analyzed contracts and claim systems to apply appropriate benefit amounts.

•Researched medical claims for validity to resolve discrepancies.

•Maintained comprehensive database for enrollment data, claim submission and payment information.

CLAIMS ADJUSTER

Ranstad Richmond, VA March 2020 - December 2021

•Reviewed, evaluated, and adjusted claims to promote fair and prompt settlement.

•Negotiated and settled claims according to information presented through reports, research, and data verification.

•Reviewed data to verify validity of claims and determine case management actions.

•Coordinated benefits while applying applicable deductibles, co-insurance, and out-of-pocket costs.

FRAUD ANALYST

DailyPay Richmond, VA April 2019 - March 2020

•Conducted reviews of flagged transactions and reports that showed potential suspicious activity.

•Input information regarding fraud investigations into detailed reports for submission to clients.

•Prepared, documented, and assembled evidence for potential prosecution and civil litigation.

•Monitored real-time queues and analyzed high-risk transactions from specified points of sale within business portfolio.

PROCESSING SPECIALIST

Conduent Midlothian, VA May 2016 - March 2019

•Input client information into spreadsheets and company database to provide leaders with quick access to essential client data.

•Communicated by telephone and email for routine exchange of information.

•Coordinated with customers to resolve problems regarding process _discipline, data accuracy, and data integrity.

•Answered incoming phone calls and directed callers to appropriate _departments and personnel.

•Entered data into spreadsheets, documents, and databases with a high _accuracy rate.

EDUCATION

High School Diploma - Huguenot High School, Richmond, VA

June 2017

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