Shaniah Turner
North Chesterfield
Summary
Detail-oriented and dedicated Claims Representative with over a year of experience in customer service and healthcare claims. Expertise in managing high-volume inquiries, resolving customer issues, and maintaining accurate documentation. Skilled in Microsoft Office (Word, Excel, Outlook) for correspondence, data entry, and email management. Strong problem-solving abilities and commitment to delivering efficient, high-quality customer support within the claims industry.
Overview
2
2
years of professional experience
Work History
Care Team Representative
Sedgwick
04.2024 - Current
- Collect and document all pertinent customer information to streamline communication and accelerate claim resolution processes
- Maintain detailed records of customer interactions, ensuring clarity in communication and efficiency in the claims process
- Address customer inquiries and resolve issues on initial contact through active listening, product knowledge, and adept problem-solving
- Escalate complex cases to specialized teams with comprehensive briefs, contributing to a smooth resolution and enhanced customer satisfaction
Health Coverage Eligibility Specialist
Maximus
02.2023 - 09.2023
- Evaluated customer information in accordance with eligibility rules and regulations to make informed determinations for health coverage
- Verified customer data through system interfaces to maintain accuracy in eligibility assessments
- Provided customer support via phone, addressing inquiries and assisting with health coverage eligibility questions
Customer Service Representative
Maximus
10.2022 - 01.2023
- Addressed a high volume of phone inquiries with prompt and effective solutions, demonstrating exceptional communication and problem-solving skills
- Utilized telephones, email, and web browsers to assist customers, showing adaptability and a strong technical aptitude in navigating various technology platforms
- Guided customers through online application processes with meticulous attention to detail, ensuring compliance with application requirements and a smooth experience
- Maintained comprehensive electronic call logs with accurate documentation of caller interactions, resolutions, and required follow-up actions, reflecting robust organizational skills
Education
High School Diploma -
Dinwiddie High School
Skills
- Customer Service Excellence: Over 1 year of experience in high-volume customer support, specializing in healthcare claims and eligibility
- Claims Processing & Eligibility Determination: Knowledge of claims procedures and healthcare coverage eligibility
- Microsoft Office Proficiency: Skilled in Microsoft Word (creating correspondence, templates), Excel (data entry, sorting/filtering), and Outlook (email management, calendar management)
- Problem Solving & Conflict Resolution: Strong ability to address and resolve complex customer issues
- Attention to Detail: Excellent at managing and documenting claims-related information with precision
- Time Management & Organizational Skills: Capable of managing workload efficiently while meeting deadlines and maintaining high standards of accuracy
Accomplishments
- Conducted regular quality assurance reviews, reducing processing errors by 20% through meticulous review and adherence to quality control protocols.
- Reduced application processing time by 30% through streamlined workflows, consistently exceeding daily targets and handling up to 100 applications per day.
Key Achievements
- Reduced Processing Errors: Contributed to a 20% reduction in processing errors through regular quality assurance checks and adherence to protocols.
- Increased Customer Satisfaction: Enhanced customer satisfaction scores by 20% by providing timely issue resolution and proactive follow-ups.
- Streamlined Workflows: Reduced application processing time by 30%, consistently exceeding daily targets by handling up to 100 applications per day.
Timeline
Care Team Representative
Sedgwick
04.2024 - Current
Health Coverage Eligibility Specialist
Maximus
02.2023 - 09.2023
Customer Service Representative
Maximus
10.2022 - 01.2023
High School Diploma -
Dinwiddie High School
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