SHAQUAILA GRAHAM
Columbia,SC
Summary
Skilled claims processing professional with extensive experience in reviewing and validating insurance claims. Strong focus on accuracy, problem-solving, and effective communication. Known for collaborative approach and adaptability to changing needs. Proficient in claims software, data entry, and customer service. Recognized for reliability and achieving results in team environments.
Gifted in working with stressed, confused and upset individuals in need of benefits information and supportive guidance to navigate multiple systems. Effective at operating within company regulations and compliance department guidelines to manage telephone calls, emails, letters and in-person requests for assistance.
Overview
6
6
years of professional experience
Work History
Claims Processor
Navitus
07.2022 - Current
- Managed high volume of claims, prioritizing tasks to meet deadlines without sacrificing quality.
- Reviewed and analyzed claims to ensure accuracy, completeness, and compliance with company policies.
- Reviewed applications and supporting documents to verify claims eligibility and accuracy.
- Managed workload and priorities to meet claims processing meet deadlines.
- Utilized specialized software to process incoming claims, enter data and generate reports.
- Followed up with customers on unresolved issues.
- Evaluated accuracy and quality of data entered into agency management system.
- Maintained strict confidentiality when dealing with sensitive information about patients'' medical histories or personal details.
Insurance Customer Service Representative
Concentrix
12.2021 - 05.2022
- Managed high call volume while maintaining professionalism, empathy, and attention to detail in each interaction.
- Processed policy updates and changes accurately, ensuring client needs were met in a timely manner.
- Answered incoming phone calls to articulate product value to prospective customers and support current policyholders.
- Documented customer interactions and transactions for accurate, up-to-date records.
- Enhanced customer satisfaction by addressing and resolving insurance-related inquiries and concerns.
- Assisted customers with completing insurance documents to avoid missed information.
- Processed insurance policy cancellations and renewals quickly to meet call time targets.
- Assisted clients in filing claims, coordinating with adjusters to expedite the process and secure fair settlements.
- Fielded customer complaints, escalating complex issues to management for resolution.
Customer Service Representative
QVC
08.2020 - 12.2021
- Resolved customer complaints with empathy, resulting in increased loyalty and repeat business.
- Responded to customer requests for products, services, and company information.
- Maintained detailed records of customer interactions, ensuring proper follow-up and resolution of issues.
- Collaborated with team members to develop best practices for consistent customer service delivery.
- Trained new Customer Service Representatives on company policies, procedures, and best practices.
- Conducted training sessions for new hires, ensuring consistent level of service across team.
- Boosted team morale by consistently recognizing colleagues' contributions and achievements.
- Analyzed customer service metrics to identify trends and develop strategies for improvement.
TEAM ASSOCIATE
Walmart
06.2019 - 07.2020
- Customer Servic
- Self-Checkout Host
- Cash Handling and dropping of tiles smooth in and out process helping customers
- Contributed to team success by completing jobs quickly and accurately
- Pursued learning opportunities to advance knowledge and take on leadership position
- Kept work areas clean, organized and safe to promote efficiency and team safety
- Operated register to process payments and collect cash payment for order totals
- Kept work areas clean, organized, and safe to promote efficiency and team safety.
- Learned all required tasks quickly to maximize performance.
Education
High School Diploma -
South Florence High School
Florence, SCSkills
- Claims review
- Accuracy and precision
- Transactions reconciliation
- Claims
- Claims processing software
- Rx Pharmacy
- Professionalism and ethics
- Medical terminology
- Data entry proficiency
- Payments posting
- Claims trend analysis
- Attention to detail
Accomplishments
- Used Microsoft Excel to develop inventory tracking spreadsheets.
- Resolved product issue through consumer testing.
- Telephone Service - Professionally processed 80+ calls per day, providing information and service to ensure customer satisfaction.
Timeline
Claims Processor
Navitus
07.2022 - Current
Insurance Customer Service Representative
Concentrix
12.2021 - 05.2022
Customer Service Representative
QVC
08.2020 - 12.2021
TEAM ASSOCIATE
Walmart
06.2019 - 07.2020
High School Diploma -
South Florence High School
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