Customer Care Claims Processing

Jamisha Carter-Hunter

305-***-**** / ********@*****.*** / Valdosta, Ga 31602

CAREER SUMMARY

Dedicated and detail-oriented professional with a solid background in claims processing within quality and production environments. Adept at efficiently reviewing and adjudicating claims to ensure accurate and timely resolution. Proven ability to contribute to member satisfaction and retention through the provision of high-quality claim service. Exceptional analytical skills, effective communication, and a commitment to exceeding quality metrics. Seeking a challenging role to leverage my expertise in claims processing and contribute to the success of a progressive organization.

WORK EXPERIENCE

RemX

Claim Benefit Specialist Jul 2019 - Present

•Review and adjudicate claims in accordance with processing guidelines, consistently meeting quality and production standards.

•Determine and understand the coverage provided under members’ health plans, ensuring accurate and timely resolution.

•Efficiently use multiple systems and screens to obtain and record claim information, contributing to streamlined processes.

•Identify claim cost management opportunities and refer claims for follow-up, optimizing overall claim resolution.

•Make claim payment decisions, enhancing customer satisfaction and retention.

RemX

Claims Processor Jan 2017 – Jun 2019

•Processed a high volume of insurance claims daily, maintaining a 99% accuracy rate.

•Conducted thorough investigations to validate claims, resulting in a 20% decrease in disputed claims.

•Collaborated with legal teams to prepare documentation for claims litigation, achieving a 15% success rate in legal resolutions.

•Monitored claims trends and provided insights to underwriting teams for risk assessment.

Selectquote

Lead Customer Care Specialist Aug 2014 – Jan 2017

•Managed and resolved complex customer inquiries, achieving a 98% accuracy rate.

•Implemented a knowledge base for customer care representatives, resulting in a 20% reduction in resolution times.

•Conducted regular quality assurance audits of customer interactions, achieving a 98% compliance rate.

•Collaborated with product teams to address customer concerns, contributing to a 15% improvement in product enhancements.

Inktel Customer Relations

Customer Care Associate Jan 2007 – Aug 2014

•Provided timely and accurate support to customers, achieving a 95% customer satisfaction rating.

•Demonstrated proficiency in issue resolution, resulting in a 20% reduction in escalated cases.

•Consistently met or exceeded individual performance metrics, including call quality and average handling time.

•Contributed to the development of new customer training materials, improving consistency in customer interactions.

EDUCATION

Georgia Military College

Associates in Psychology (Current)

Booker T. Washington Sr. High School

Graduated 06/2002

Miami Florida

QUALIFICATIONS

Experience in claims processing within a quality and production environment.

Detail-oriented with a strong attention to detail.

Proficient in using multiple computer applications simultaneously.

Exceptional analytical skills and accurate keyboarding abilities.

Advanced computer navigation and knowledge in a Windows environment.

Effective verbal and written communication skills.

Abilit to adapt quickly and willingly to change.

SKILLS

Claims Processing Quality and Production Standards

Attention to Detail Analytical Skills

Computer Navigation Customer Service

Team Collaboration Adaptability

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