Customer Service Risk Management

CONSTANCE MILLER

Charlotte, NC 646-***-**** **********@*****.*** LinkedIn

PROFESSIONAL SUMMARY

Detail-oriented and results-driven Claims Professional with extensive experience in claims analysis, fraud investigation, customer service, and risk management. Adept at liability investigations, negotiating settlements, and collaborating with cross-functional teams to deliver exceptional customer experiences while ensuring compliance with industry regulations. Proven ability to evaluate risk potential, investigate casualty claims, and execute policy agreements. Strong communicator and problem-solver, capable of handling complex claim resolutions with a customer-first mindset.

CORE SKILLS & COMPETENCIES

Claims Investigation & Resolution

Liability Assessment

Policy Interpretation

Fraud Prevention & Risk Analysis

Negotiation & Settlement

Customer Advocacy & Retention

Compliance & Regulatory Standards

Workflow Optimization

Escalation & Conflict Management

Microsoft Office Suite CRM Tools Salesforce Peoplesoft

PROFESSIONAL EXPERIENCE

Insurance Sales Representative

Blue Cross & Blue Shield NC 2022 – Present

Conduct policy investigations and claim resolutions, ensuring accurate processing and compliance with industry standards.

Lead liability assessments and identify risk exposure to enhance claim decision-making and mitigate potential losses.

Manage claimant inquiries and provide clear, empathetic communication to support claimants through policy decisions and adjustments.

Utilize data-driven insights to analyze call trends and recommend process improvements that optimize workflow efficiency.

Foster cross-functional collaboration with claims adjusters and fraud analysts to improve claim handling and customer satisfaction.

Medicare Insurance Agent

TTEC (USAA) 2020 – 2021

Performed casualty and property investigations, identifying potential risk factors and coverage liabilities.

Delivered high-quality customer support by guiding clients through policy coverage options, claims processes, and settlements.

Maintained compliance with federal and state regulations while ensuring an efficient, fair claims resolution process.

Utilized CRM software to track client interactions, document findings, and ensure thorough case management.

Property and Casualty Licensed Insurance Agent

TTEC (USAA) 2019 – 2020

Investigated liability claims, assessed damages, and facilitated negotiations with customers, vendors, and third parties.

Provided clear, concise, and empathetic communication while working through complex claims, resulting in higher customer retention rates.

Reviewed claim documentation, verified policy coverage, and identified potential fraud concerns to mitigate risks.

Payroll Clerk

US FOODS 2018 - 2019

Analyzed financial data and processed payments efficiently, ensuring accuracy in documentation and compliance with regulations.

Partnered with cross-functional teams to resolve discrepancies, improving efficiency and reducing transaction errors by 25%.

Pension Benefits Analyst

ACS GROUP 2016 - 2017

Conducted benefit calculations and claims investigations, ensuring proper documentation and regulatory compliance.

Provided guidance on employment regulations, compensation strategies, and risk management.

EDUCATION & CERTIFICATIONS

Bachelor of Arts in Communications College of New Rochelle

Licenses:

Accident & Health or Sickness, Life, Med Supp/Long Term Care, and Personal Lines Insurance Producer

HIPPA, AHIP

KEY QUALIFICATIONS FOR CLAIMS RESOLUTION ADJUSTER ROLE:

Liability Investigations: Strong background in assessing coverage, investigating claims, and mitigating risks.

Negotiation & Settlement: Experienced in claim resolution, settlement negotiations, and policy interpretation.

Regulatory Compliance: Well-versed in industry regulations, compliance audits, and fraud prevention strategies.

Customer-Centric Approach: Adept at guiding claimants through the claims process with empathy and efficiency.

Remote Work Ready: Experienced in utilizing digital tools, CRM systems, and virtual communication for remote claims handling.

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