Customer Service Specialist
Resume:
SHANNON JONES
*************@*****.***
JACKSONVILLE, FLORIDA 32221
Professional Summary
I have been in the Claims/ Customer Service field for over 10 successful years. With the proven ability to contribute to members’ satisfaction and retention through the provision of high-quality claims and customer service. I have an excellent track record of analytical skills, resolving issues, and exceptional communication skills as well as a commitment to exceed quality metrics. A clear understanding of performing duties and executing my responsibilities in a timely manner. A motivated employee with excellent decision-making abilities. I have been recognized on numerous occasions for outstanding performance and contributions. I am a dedicated Claims/Customer Service Specialist and Claims Adjuster, with the room to continue to learn and grow.
Skills
Claims Processing Customer Service
Proficiency in Computer Navigation Claims Specialist
Teamwork and Collaboration Multitasking Abilities
Planning and Coordination Problem Solving
Critical Thinking Microsoft, Words, Power Point Materials
Excellent Communication Detail Oriented
Analytical Skills Vendor Relationship Management
Professional Experience
April 2024 – Nov 2024: Corporate Brokers-Prudential (Claim Benefit Specialist))
Jacksonville Florida
•Verifying information and assessing claim validity.
• Facilitating communication between the insured party and the insurer service provider.
•Efficiently gather document information related to new claims in our claims systems.
•Guide members through reporting a new claim and set appropriate expectations.
•Ensure adequate documentation is available to provide the necessary support.
•Accurately document all customer interactions and claim details in various systems.
•Identify problem areas/issues; recommends corrective action.
•Field calls from members inquiring about the status of their existing claims.
•Examining insurance claims to determine if they are covered, and if there is evidence of fraud.
•Completing forms, reports, and logs to record claims.
•Maintaining confidentiality while keeping claims information confidential.
•Approving or denying claim, calculating benefits, and determining compensation.
•Determined and understands the coverage provided under the members health plan.
•Make claim payments decisions, enhancing customer satisfaction and retention.
July 2019 – April 2024: Williams-Sonoma, Inc. (Customer Care Agent)
Jacksonville Florida
•Directly interacted with customers via phone, email or chat to address inquiries.
•Resolved complaints, provided information about products or services.
•Investigating complaints, identifying the root cause of the problem.
•Updating customer information and tracking interaction within the company.
•Handling order changes, returns, refunds and other customer requests.
•Ensure customer queries are attended to in a timely and accurate manner.
•Escalation of technical issues.
January 2017 – June 2019: Aetna (Claims Processor)
Jacksonville Florida
•Identifies jurisdiction, date of injury and special handling items.
•Receives incoming general new claims calls for all entities.
•Confirms policy coverage for date of injury, business location and injury location; request policy updates as needed.
•Routes documents to medical bill review vendor.
•Make changes, corrections, and updates on newly created and existing claims.
•Processed claims payments when applicable to ensure they comply with federal, state and company regulations and policies.
•Assess the situation and gather all necessary information.
•Obtain information from policyholders to verify the accuracy and completeness of information on claim forms, application and related documents and company records.
•Handles incoming correspondence (both calls and emails) to assist lenders, borrowers and third-party administrators.
•Update reports and trackers to maintain history of all the claims
•Adjudicate claims and adjustments as required.
•Monitored claims and provided insights to the underwriting team for risk assessment.
•Manually prices claim; as well as process to pay claims.
August 2014 – January 2017: Citibank (Lead Customer Care Specialist)
Jacksonville Florida
•Resolved escalated customer issues.
•Develop customer service policies and procedures.
•Ensure employees operate within guidelines.
•Collaborated with other teams to address customer concerns.
•Managed and resolved complex customer inquiries, achieving 98% accuracy rate.
•Conducted regular quality assurance audits of customer interactions, achieving a 98% compliance rate.
•Implemented a knowledge base for customer care representatives.
•Coordinates and supervised the daily activities and operations.
•Administered and executes policies and procedures.
•Identifies and solve problems, as well as pay attention to detail.
•Develop a good work environment with excellent teambuilding skills.
January 2012 to August 2014: Sterling National/ Spherion (Customer Care Associate)
Jacksonville Florida
•Consistently met or exceeded individual performance metrics, including call quality and average handling time.
•Investigate and resolve customer issues in a timely manner.
•Identify when issues need to be escalated to higher management.
•Compile reports on customer interactions and inquiries.
•Work with other teams to provide good customer experience.
•Strong customer service skills with the ability to remain professional and patient.
•Manage input on the customer feedback database and to the monthly Customer Care Report.
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•Pulled orders from inventory using RFID scanners and documented disposition of materials and supplies by recording units delivered and their locations.
•Gathered all documentation for outbound freight and ensures all documents including receiving paperwork are filed appropriately.
EDUCATION
General Education Diploma
Bachelors/ Accounting/ Colorado Technical University
REFERENCE UPON REQUEST
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