Customer Service Claims Adjuster
Resume:
TAKETRA
BOYD
CLAIMS ADJUSTER
***********@*****.***
Coral Springs, FL 33076
CONTACT
SKILLS
• Process Optimization
• Medical Terminology Knowledge
• Customer Relations
• Stocking and Replenishing
Organized professional with experience in the insurance industry. Skilled in providing excellent customer service and solving complex claims issues. Proven ability to develop and maintain strong working relationships with clients. Adept in data analysis and dispute resolution techniques. Results-driven individual with a proven track record of successfully resolving a wide range of claims cases. Proven ability to manage multiple cases simultaneously, build strong relationships with clients and handle sensitive information discreetly. Adept in data analysis and process optimization.
CAREER OBJECTIVE
CSR/ Claims Advocate
Cigna, Remote, FL
Database Management
Affinity Adjuster
Crawford And Company, Sunrise, FL
EXPERIENCE
August 2023 - Present
• Daily Logs, In this pivotal role, my job as an Intake Customer Service Advocates field, requires me to handle incoming calls from Cigna customers to initiate the setup of FML
•
• PFL, ADA, STD and LTD claims
Entering information gathered via telephone to open the requested leave/claim with high level of accuracy
•
Being required to ensure successful transmission of this information to the appropriate location within targeted time frames
•
• All activities for this position are performed under the guidance of the Team Identified potential opportunities for product improvement by analyzing customer data trends.
•
December 2021 - May 2023
• Identified areas of improvement in the claims process and proposed solutions.
• Analyzed data and prepared reports for management review.
• Performed detailed investigations to evaluate liability and damages.
• Conducted investigations into suspicious or fraudulent claims.
• Managed multiple projects simultaneously while meeting tight deadlines.
• Collaborated with various departments to ensure compliance with state laws. December 2021 - April 2023
Tax Associate
Intuit, Remote, FL
Project Supervisor-CDC
Maximus Technical, Remote, FL
Project Supervisor - DEO
Titan Technologies, Remote, FL
Secured and properly handled confidential data to protect against unauthorized access, improper transmission and unapproved disclosure.
•
Assisted businesses with provisions, international tax issues, multi-state issues and mergers and acquisitions to comply with tax regulations and reduce audits.
•
• Maintained client confidentiality in accordance with IRS guidelines. Participated in team meetings discussing new developments in taxation policies and procedures.
•
March 2021 - October 2021
• CDC Vaccination Hotline, Customer Service (Remote) Ensured that US Citizens received most up to date information so that were able
• to schedule and obtain their
• COVID-19 Vaccinations
Remained responsible for following CDC Guidance and information to assist callers who have questions regarding
•
• COVID-19 and
Vaccinations available and process and information needed to resolve concerns regarding vaccines and requirements
•
Took responsibility of putting forward Customer Conscious attitude on phones in effort to assist callers; as well as meet Key Performance
•
• Indicators that Project Manager put in place ranging from Talk Time
• Hold Rate and Dead Air Policy and Quality Call Monitor February 2020 - December 2020
Monitored, coached, and supported incentive programs to motivate staff towards achieving results; supports staff development of call handling skills
•
Provided leadership and direction while maintaining team's morale, to at least
• 50 agents
Ensured staff's performance, quality, productivity, and attendance standards are met, posts statistics as appropriate
•
Encouraged continuous improvement; involved others in planned process improvement efforts and measures; encouraged/coached individuals to follow systematic improvement processes
•
Participated as member of supervisory team, cooperated with peers to build
• consensus, and share responsibilities
Contributed to discussions, actions, and projects and helps resolve indifference or conflicts by identifying common ground and exploring potential solutions
•
Assists human resources by interviewing prospective candidates and processing voluntary and involuntary terminations
•
Workers' Compensation Claims Adjuster
York Risk Services, Boca Raton, FL
AMS Claims Examiner
Matrix Absences Management, Ft. Lauderdale, FL
Student- Returned to college
Maintained attendance records, processed employee paperwork, submits payroll information as required and to support administration in accurate and timely fashion
•
Provided meeting leadership, management, and facilitation; prepared for meetings in advance and follows up with a complete meeting record to participants
•
Supports department projects as needed including any special assignments/working hours
•
Handled customer complaints, resolved issues and adjusted policies to meet changing needs
•
Applied strong leadership talents and problem-solving skills to maintain team
• efficiency and organize workflows.
October 2018 - February 2020
Investigate and analyze injuries and determining plan of action to monitor and organized claims, always making good faith decision
•
Created detailed reports, coordinated, and evaluated more complex claims issues, ultimately ending with positive resolution
•
Discussing, negotiating and settlement of claims with attorneys, service
• providers, and clients
• Verified insurance claims and determined fair amount for settlement
• Examined claims forms and other records to determine insurance coverage. December 2017 - October 2018
Being accountable for the decision-making process for determining eligibility
• under federal, state laws and client policy
Secure and analyze information to approve decisions on all short-term disability, FMLA,insured or self-insured, and/or statutory claims, and their concurrent leave claims
•
Develop and apply appropriate claim and workflow management strategies, coordinating both disability and leave decisions while meeting timeliness regulations
•
Pro-actively communicate decisions within Best Practice guidelines, consistently
• meeting all performance guarantee requirements
Reviewed new files to determine current status of injury claim and to develop plan of action
•
Reported policy changes and company conditions affecting customer satisfaction.
•
• Palm Beach State
• Returned back to college to finish my degrees
August 2012 - May 2017
Palm Beach College, Boca Raton, FL
Senior Workers' Compensation Claims Adjuster
Cambridge Intergraded Services, Pompano Beach, FL
Claims Examiner II STD/LTD
Broadspire, Plantation, FL
PIP Adjuster
Progressive Insurance, Oakland Park, FL
• Collaborated with fellow students, working on group projects and assignments. Met academic expectations by displaying values of teamwork and unity in collaborative learning environment.
•
• Developed and presented reports on assigned topics. Demonstrated desire to learn by earning high marks on challenging coursework and quizzes.
•
March 2007 - May 2012
Identified fraudulent activity through proactive review of submitted documentation.
•
Coordinated communication between departments within organization to
• ensure proper handling of claims-related inquiries. Analyzed claim forms and supporting documentation for completeness, accuracy and adherence to applicable laws and regulations.
•
Resolved difficult cases by conducting detailed investigations into complex claims issues.
•
Advised on claims-related questions from internal staff as well as external
• customers.
Negotiated settlements with claimants, attorneys and other parties involved in the claim process.
•
June 2004 - March 2007
• Evaluated and managed short- term disability claims from clients Made outbound calls to providers to obtain supporting documentation to
• determine employee's disability status
Notified managers of time frames for leaves, return to work dates and/or modified duty with any restrictions, if needed
•
• Authorized and processed payments to employees, while out on disability Reviewed new files to determine current status of injury claim and to develop
• plan of action.
October 2005 - February 2007
Investigated and medically controlled personal injury protection claim, to maintain positive outcome for all claimants
•
Processing loss wage claims and payments to clients in addition to submitting payments to medical providers for all services rendered
•
• Identify special investigation fraud indicators and referred files accordingly Reviewed police reports, medical treatment records and physical property damage to determine extent of liability.
•
MBA in BUSINESS ADMINISTRATION AND MANAGEMENT
Florida International University (FIU), Miami
BACHELOR OF SCIENCE in OPERATIONS MANAGEMENT AND
SUPERVISION
Palm Beach State College, Boca, Raton
ASSOCIATE OF SCIENCE in LIBERAL ARTS AND GENERAL STUDIES Palm Beach State College, Lake Worth
ASSOCIATE OF ARTS in GENERAL EDUCATION, Coconut
Creek Broward College
COMPLETED
CERTIFICATIONS LICENSED ADJUSTER - 620- ALL LINES
EDUCATION
May 2017
May 2014
May 2013
April 2013
References available upon request
REFERENCES
Contact this candidate