Celethia Chatmon
Norfolk
Summary
Highly accomplished and results-driven professional with 16 years of comprehensive experience in complex claims resolution, advanced customer advisement, and administrative optimization. Proven expertise in expediting high-volume insurance claims, significantly improving customer satisfaction, and meticulously managing sensitive financial data and personal data. Adept at navigating intricate regulatory compliance, streamlining benefits explanations, and strategically resolving critical issues within fast-paced, high-pressure environments. Actively seeking a Senior Claims Specialist or similar leadership position to leverage a robust background in impactful claims management, dispute mitigation, and cross-functional collaboration.
Professional with comprehensive experience and readiness for role. Known for strong focus on team collaboration and achieving results. Adaptable and reliable, supporting colleagues effectively and responding to changing needs. Skilled in communication, problem-solving, and client relations. Recognized for integrity, determination, and results-driven approach.
Overview
18
18
years of professional experience
Work History
Specialty agent
Geico
09.2025 - Current
- Optimize workflow efficiency using proprietary CRM software to accurately document risks and reduce policy processing time
- Adhering to strict underwriting guidelines while navigating complex, multi-layered specialty risk profiles
- Managed high-volume portfolio of specialized policies (Boat, Motorcycle) consistently
- Elevated customer experience through expert technical knowledge and swift resolution of complex coverage disputes.
- Processed premium payments with 100 % accuracy, ensuring adherence to strict PCI compliance and corporate financial protocol
- Managed customer inquiries, providing accurate information and solutions to enhance satisfaction.
- Developed comprehensive knowledge of insurance products, assisting clients in making informed decisions.
Reimbursement Specialist
CareMetx
11.2024 - 03.2025
- Collect and review all patient insurance benefit information for accuracy
- Provided assistance to physician office staff and patients to complete in person and online documents
- Proficiently document all calls with providers, third party, pharmacy staff and their representatives
- Processed and submitted reimbursement claims, ensuring compliance with federal regulations and internal policies.
- Collaborated with healthcare providers to resolve billing discrepancies and expedite claim approvals.
Member Support
Smith Rx
11.2023 - 03.2025
- Provide comprehensive member support, adeptly handling inquiries, resolving issues, and facilitating seamless healthcare services to ensure optimal member satisfaction and retention in a call center environment.
- Processed prior authorizations for medications and medical services, ensuring timely approval and compliance with insurance guidelines.
- Managed Worker's Compensation claims for Berkley Medical, accurately processing documentation and coordinating with all relevant parties to facilitate claim resolution.
- Acted as a primary point of contact for members, guiding them through complex healthcare processes and benefit explanations and payment requirements with estimated cost.
- Updated on HIPPA policy and privacy, Microsoft Teams, Troubleshooting, Performance Metrics and Adherence
- Boosted membership retention by implementing effective communication strategies and providing personalized member support.
- Participated in ongoing training sessions to stay updated on industry trends, products, and best practices for exceptional member support.
Customer Service Agent
Liberty Tax Service - Remote
01.2012 - 11.2023
- Provided exemplary customer service through prompt responses to customer inquiries via calls and emails, and virtual ensuring high customer satisfaction.
- Managed multiple tasks with high attention to detail, effectively organizing and prioritizing customer-related projects.
- Analyzed and resolved customer issues by evaluating pertinent information and recommending appropriate solutions to maintain service quality.
- Accurately documented customer interactions, problems, payments and resolutions in the sales system for efficient tracking and service continuity.
Insurance Claims Specialist
Advanced Diagnostics MRI
04.2008 - 01.2012
- Analyzed and resolved complex insurance claims within established deadlines, ensuring compliance with procedural guidelines.
- Advised customers on insurance claims processes and rights, facilitating clear communication to prevent disputes.
- Conducted thorough verification of documentation and collaborated with relevant parties to ascertain fault percentages, mitigating potential losses.
- Call center management and training
Education
High School Diploma - General Education
FairPark High School
Shreveport, LA10.1998
Skills
- Claims Resolution & Processing: Complex Claim Analysis, Dispute Resolution, Regulatory Compliance, Documentation Verification, Fault Assessment, Prior Authorizations, Worker's Compensation
- Customer Service & Communication: Customer Advisement, Conflict Resolution, Active Listening, Written & Verbal Communication, Call Center Operations, Benefits Explanation
- Data Management & Administration: Confidential Information Handling, Accurate Documentation, Billing Adjustments & Refunds, Office Inventory Management, Microsoft Access
- Problem Solving & Organization: Multi-tasking, Prioritization, Independent Work, Detail-Oriented, Issue Tracking
- 7 years customer service experience in a call center environment
- Problem-solving skills
- Positive attitude
Timeline
Specialty agent
Geico
09.2025 - Current
Reimbursement Specialist
CareMetx
11.2024 - 03.2025
Member Support
Smith Rx
11.2023 - 03.2025
Customer Service Agent
Liberty Tax Service - Remote
01.2012 - 11.2023
Insurance Claims Specialist
Advanced Diagnostics MRI
04.2008 - 01.2012
High School Diploma - General Education
FairPark High School