Client Services Customer Experience

**** ****** ***** ***** ************, OH ***** 614-***-****

*********@*****.***

Qualifications Summary

Highly personable Client Services Professional with experience in call-center operations within the healthcare industry.

Talent for identifying client needs and presenting appropriate solutions.

Demonstrated ability to gain client trust and provide exceptional follow-up.

High degree of initiative and independent judgment.

Ability to organize work and manage a variety of tasks simultaneously.

Proficient with Microsoft Office System.

Professional Experience

StateFarm 2022-Present

Claim Specialist- Injury (June 2022-Present)

Delivered a remarkable customer experience through handling claims involving injury

Investigated, evaluates, negotiates, and settles auto claims in an assigned area to include verification of coverage, legal liability and extent of damage to persons and property, which may require contact by telephone, correspondence, in person, or various electronic media

Applied knowledge of policies, procedures, laws, statutes, and insurance regulations when determining coverage, liability, damages of injury (first and third party) and property damage

Recognized and reviews claims requiring specialized handling, including identifying issues that may require the use of independent experts or vendors

Used various electronic resources for claim handling

Worked in partnership with and provides instruction to claim assoc

Bureau of Workers Compensation 2016 to 2022

Workers Compensation Specialist (August 2016 -June 2022)

Managed processing of medical provider in-claim services through BWC’s Cambridge billing systems.

Charged and made determinations to pay, deny, and adjust in-claim medical charges associated with pre-Health Partnership (HPP) provider billing, Managed Care Organization (MCO) billing, settlement claims, and non-routine billing for non-HPP business.

Completed research, bill payment, on adjustments on written and phone billing inquiries.

Prepared comprehensive written responses.

Assisted Management in planning, analysis and suggestions regarding the implementation of solutions to problems.

Healthscope Benefits, Columbus Ohio 2014 to 2016

Claims Analyst (June 2014- August 2016)

•Processed and evaluated medical and dental claims

•Obtained information by telephone as well as by hard copy and entering into the computer systems

•Prioritization of individual work flow associated with the case assignments

•Established and maintaining professional rapport with clients and providers (physicians and hospitals)

•Maintained and assured accuracy of documentation.

CareworksUsa., Dublin Ohio 2013 to 2014

Absence Management Specialist (November 2013-June 2014)

Processed disability/FMLA paperwork

Analyzed FMLA claims to determine eligibility and certification in compliance with state and federal regulations

Communicated absence and return to work information to client

Consulted with nurse case manager regarding claim, as appropriate

Coordinated certain types of leaves with client Human Resources Department

Communicated decisions and on-going expectations with claimants and clients

Adhered to communication and workflow timeframes

Tracked FMLA absences, per client calendar

Troubleshoot disability and absence issues

Verified return to work status

Accomplishments

Member of Omega Psi Phi Fraternity Incorporated Upsilon Chapter

Participated on a community service project for Habitat for Humanity

Education and Training

Bachelor of Science Psychology – Wilberforce University – Wilberforce OH., May 2005

Masters of Healthcare Administration-University of Phoenix-Online May 2019

References

Upon request

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