Customer Service Workers' Compensation
Resume:
Talita P Everette
Hampton, VA *****
********@*****.***
Professional Summary
I am currently seeking a full time remote position as a Claims Specialist. I would like to showcase my skills in processing, investigating, and resolving claims. I have over 20 years of Customer Service experience, which has allow me to exude my diverse knowledge in assessing the validity of the medical claim by gathering evidence, documentation, negotiating settlements, and pay outs. I am a expert in managing high-volume inbound and outbound calls, coordinating workers' compensation cases, and processing healthcare claims with efficiency and accuracy. I am seeking a challenging skilled role to leverage strong problem-solving abilities, communication skills, and a customer-focused approach. Authorized to work in the US for any employer
Work Experience
Team Lead
Newport News Waterworks-Newport News-VA
September 2020 to Present
• Delivered exceptional customer support by efficiently handling 50-60 daily inbound calls, addressing and resolving billing inquiries.
• Coordinated scheduled meter tests to verify accurate calibration and functionality, enhancing service reliability.
• Facilitated the creation of repair tickets for both commercial and residential meters, ensuring accuracy in billing and record maintenance.
Workers' Compensation Claims Examiner
Hammond Townsend VA Workers'-Remote
February 2019 to August 2023
• Coordinated workers' compensation cases, ensuring effective development, implementation, and monitoring of return-to-work and rehabilitation strategies.
• Facilitated the scheduling of medical appointments with appropriate healthcare providers for all injured employees.
• Devised comprehensive care plans to meet the needs of both short-term and long-term patients with chronic and serious health conditions.
• Determined coverages on new claims.
• Contacting employer for initial investigation.
• Contacting employee/injured worker for information – recorded statements
• Reviewed medical bills to determine if payment is proper and referral of the bills were ready for audit.
• Filed forms with the Industry Commission.
• Made determination that were appropriate to reserve for that claims.
• Determined when the claims needed a medical case management services and assisted with arranging the necessary care.
• Corresponded with attorneys on legal issues.
• Attended mediations and claim hearings.
Healthcare Claims Representative
WPS Health Solutions-Hampton, VA
March 2017 to January 2019
• Processed and adjudicated healthcare claims, ensuring compliance with military insurance policies and coordinating with secondary coverage providers such as Humana and Tricare.
• Managed claimant appointments and meticulously documented personal information for disability social security submissions, while securing essential documents to expedite claim processing.
• Resolved claims effectively by evaluating documentation, calculating benefits, and determining compensation settlements, demonstrating strong communication abilities and problem-solving skills in a high-volume setting.
Customer Delivery Specialist
DHL-Newport News-VA
March 2014 to February 2017
• Efficiently processed and cataloged incoming packages, ensuring accurate tracking by inputting data into a digital handheld device.
• Coordinated the sorting and loading of delivery vehicles, maintaining an organized system for efficient item retrieval.
• Conducted deliveries with a strong emphasis on customer interaction, securing signatures for proof of delivery while upholding vehicle maintenance standards. Team Lead Customer Service/Sales Rep
Avis Budget Group-Newport News, VA
July 2010 to October 2016
• Facilitated new employee integration by processing onboarding documentation and managing training initiatives.
• Supported team members in enhancing sales performance through assistance with customer upgrades and promotions.
• Maintained quality customer service by matching clients with appropriate vehicles to meet their requirements.
Education
Bachelor of Science in Business and Project Management University of Phoenix-Online Campus - Phoenix, AZ
July 2024 to September 2028
Associate's degree in Business Administration
Thomas Nelson Community College - Hampton, VA
March 2019 to March 2019
Skills
• Help Desk
• Employee Evaluation
• Medical Terminology
• Communication Skills
• Medical Billing
• Interviewing
• Employee Orientation
• Computer Skills
• Software Troubleshooting
• Talent Acquisition
• Conflict Management
• Customer Service
• Account Management
• Recruiting
• Microsoft Office
• Direct Support
• Office Management
• Quality Assurance
• Typing
• E-Commerce
• Microsoft Powerpoint
• Data Entry
• Management
• Workers' Compensation
• Human Resources Management
• Human Resources
• Icd-9
• Microsoft Excel
• CPT Coding
• Windows
• Active Directory
• Documentation Review
• Customer service
• Performance Management
• Medical Coding
• Payroll
Certifications and Licenses
Driver's License
Contact this candidate