WHITNEY CLEMONS
Lexington
Summary
Hardworking, highly motivated professional eager to lend combined knowledge and skills to enhance business performance. Operates well in both individual and team capacities, leveraging seasoned work ethic to quickly adapt to different processes and drive company objectives. Resourceful and results-driven with a passion for growth and efficiency to meet company needs and increase service value.
Skilled customer service professional with strong background in claims handling and resolution. Known for exceptional communication, problem-solving abilities, and adaptability in dynamic environments. Valued team player with focus on collaboration and achieving results. Proficient in managing complex cases, ensuring client satisfaction, and maintaining compliance with industry standards.
Overview
5
5
years of professional experience
1
1
Certification
Work History
Claims Customer Service Representative
Hornet Staffing
07.2025 - Current
- Gather claims data and prepare required documentation.
- Monitors timelines for open negotiation, initiation, submission of offers and fees to ensure compliance with federal deadlines.
- Determine if the dispute is eligible for the Federal IDR Process based on the services rendered and relevant laws.
- Improved workflow efficiency with proficient multitasking and prioritization of high-priority cases.
- Optimized workload management through effective use of CRM tools, ensuring seamless tracking of case progress and efficient resource allocation.
- Supported departmental goals by consistently meeting or exceeding performance metrics in quality, accuracy, and timeliness.
- Ensured accurate documentation and record-keeping, adhering to company policies and industry regulations.
Executive Director
Learning Express
07.2022 - Current
- Provided executive leadership in setting long-term goals and objectives, creating policies, and developing procedures for the organization.
- Led teams of professionals, providing guidance, mentoring, and setting clear objectives.
- Worked with management team to develop and enhance skill set requirements, gap analysis and training plans.
Health Insurance Agent
United Healthcare
01.2022 - 07.2022
- Understood customer requirements and tailored insurance plans to fit needs.
- Assisted customers in understanding their health insurance policies and options, providing professional advice tailored to individual needs.
- Analyzed customer medical records to ensure policy coverage was appropriate for their particular situation.
- Maintained up-to-date knowledge of the health insurance industry, including applicable laws and regulations.
Customer Service Representative
Teleperformance
10.2020 - 01.2022
- Handled customer complaints and inquiries in a courteous and efficient manner.
- Demonstrated excellent communication skills, both verbal and written, in order to effectively interact with customers.
- Resolved customer complaints promptly and efficiently.
- Maintained knowledge of company products to provide helpful suggestions and recommendations to customers.
- Responded to telephone inquiries and complaints following standard operating procedures.
Education
Bachelor of Arts (B.A.) - Social Science
Southern New Hampshire University
Manchester, NH07.2022
Associate in Science (A.S.) - Criminal Justice
Orangeburg Calhoun Technical College
Orangeburg, SC05.2017
High School Diploma - undefined
Hunter Kinard Tyler
Neeses, SC05.2022
Skills
- Client Service
- Project Management Abilities
- Coaching and Counseling
- Customer Service
- Call Volume and Quality Metrics
- Training Methods
- Microsoft Office
- Staff Training
- Managing Multiple Tasks
- Delivery Claims
- Billing Procedures
- Medical Insurance
- Document Filing
- HIPAA Compliance
- IRS Correspondence
- QuickBooks Proficiency
- Customer service
- Problem-solving
- Time management
- Problem-solving abilities
- Multitasking
- Organizing and prioritizing work
- Critical thinking
- Excellent communication
- Verbal and written communication
- Adaptability and flexibility
- Microsoft office
- Computer proficiency
- Documentation skills
- Data entry
- Analytical thinking
- Data entry software
Certification
CPR and First Aid Certified
Languages
English
Native or Bilingual
Timeline
Claims Customer Service Representative
Hornet Staffing
07.2025 - Current
Executive Director
Learning Express
07.2022 - Current
Health Insurance Agent
United Healthcare
01.2022 - 07.2022
Customer Service Representative
Teleperformance
10.2020 - 01.2022
Associate in Science (A.S.) - Criminal Justice
Orangeburg Calhoun Technical College
High School Diploma - undefined
Hunter Kinard Tyler
Bachelor of Arts (B.A.) - Social Science
Southern New Hampshire University
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