Customer Service Claims Representative

Nikcole Sterling

Oklahoma City, OK ***** 805-***-**** **********@*****.***

Career Objective

Dedicated professional with extensive experience in claims handling and customer service. Actively seeking a position in a healthcare organization where I can utilize my skills in communication, problem-solving, and service delivery to ensure an exceptional provider and patient experience while advancing my professional growth.

Key Skills

• Excellent communication and interpersonal skills

• Strong problem-solving and decision-making abilities

• Skilled in handling escalations and resolving complex issues

• Familiar with Microsoft Word, Excel, Outlook, and complex pharmacy systems

• Ability to educate and promote tools and services

• Compassionate, self-aware, and dedicated to patient care Professional Experience

Sedgwick, Houston, TX

Claims Representative – Liability April 2022 - Present

• Process liability claims by gathering necessary data and determining exposure to liability.

• Document interactions and ensure claim remittances are approved and confirmed.

• Allocate reserve values and design claims to meet set authority levels.

• Collaborate with team leads and stakeholders to resolve escalated issues effectively.

• Maintain detailed documentation in internal systems to support decision-making processes. Anthem, Miami, FL

Claims Representative - Health and Dental February 2021 - March 2022

• Managed health and dental claims, ensuring client needs were met professionally and accurately.

• Assessed claims, approved payments, and coordinated client compensation procedures.

• Handled complex claims involving negotiations and settlements to ensure client satisfaction.

• Educated clients on claim processes and upheld quality standards throughout service delivery. Clear Cover, Miami, FL

Liability Claims Representative February 2018 - January 2021

• Provided excellent customer service and first-call resolution to clients.

• Conducted detailed investigations into claims to determine liability and compensation.

• Escalated and resolved disputes involving settlements and fraud-related concerns.

• Served as a liaison between clients and internal teams to ensure timely issue resolution. Education

Clinical Training Institute, Bakersfield, CA

Certified Phlebotomy Technician I

Bakersfield High School, Bakersfield, CA

High School Diploma

Relevant Achievements

• Recognized for resolving escalated issues with professionalism and urgency.

• Successfully promoted and educated clients on organizational tools and services.

• Delivered consistent quality assurance in claims handling and client service.

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