Monique Sherell Horton

Charlotte,NC

ad28d6@r.postjobfree.com

716-***-****

I am seeking a rewarding career with a reputable organization, where I can use my skills acquired over my years in the workforce. Experienced in customer service responsible for supporting software quality based on user requirements. Detail-oriented and strong problem-solving skills with experience in hospitality and financial backgrounds.

Work History

Wells Fargo (Fraud Claims Manager) 9/2021-Present

●Manage and develop a team of supervisors, analysts, specialists, or consultants, and engage management, vendors or related functional areas associated with fraud and claims investigations

●Identify and recommend opportunities for implementation of procedures, controls, and trend data to ensure proactive identification, prevention execution, detection, investigation, recovery, and government or internal reporting of fraud and claims activity

●Make decisions and resolve issues regarding fraud and claims to meet business objectives

●Interpret and develop data and reports on emerging risk in the fraud environment to implement functional area policies or procedures which will maximize efficiency and enhance customer service

●Collaborate and consult with customers, vendors, and other functional areas to resolve escalated issues

Mecklenburg County (Grievance Claim Assistant) 10/2016-09/2021

● Reviews the level 1 appeals cases and ensures that information is correct and then forwards to the CMS entity for further review.

●Investigates and resolves member and civilian issues

●make decisions regarding the daily priorities for administrative work groups

●assist member is further in support quality related goals in the County.

Erie County Medical Center (Patient Insurance Specialist) 11/2013-09/2016

●Handle assigned cases in a timely manner to identify opportunities to resolve the issue by working with plan documents, carriers, providers, and members

● Research plan information and identify where there may be conflicting information which may include escalating to supervisor or other levels of management for clarification and assistance

●Research billing issues to determine the possible cause of the error and assist with claims resubmission when needed to correct the issue

Education

July 2016, Bachelor’s in Science in Criminal Justice- Buffalo State College

December 2012, Associates in Science in Information Technology-Erie Community College

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