Kelita Shaner
Citrus Heights
Summary
Organized and dependable candidate successful at managing multiple priorities with a positive attitude. Willingness to take on added responsibilities to meet team goals. Hardworking and passionate job seeker with strong organizational skills eager to secure entry-level work from home Customer Service position. Ready to help team achieve company goals. To seek and maintain part-time position that offers professional challenges utilizing interpersonal skills, excellent time management and problem-solving skills.
Overview
11
11
years of professional experience
Work History
Appeal & Grievance Coordinator
Western Health Advantage
05.2006 - 05.2007
- Enhanced grievance resolution rates by implementing efficient tracking and monitoring systems.
- Streamlined the complaint intake process for faster response times and improved customer satisfaction.
- Reduced case backlog by prioritizing urgent grievances and effectively delegating tasks to team members.
- Improved interdepartmental communication, ensuring timely updates on case progress and resolutions.
- Conducted comprehensive investigations on complex cases, leading to successful outcomes and satisfied clients.
- Managed high caseloads diligently by effective organization strategies that maintained accuracy and timeliness during peak periods.
Customer Service / Appeals & Grievance Coordinator
Blue Shield Of CA
01.2003 - 01.2005
- Verified patients had positive experience by providing exemplary customer service.
- Resolved customer issues and complaints expeditiously to meet customer service quality standards.
- Maintained high standards of customer service in high-volume, fast-paced operations.
- Modeled best practices for sales and customer service.
- Provided excellent customer service through communication and interpersonal skills.
- Addressed customer concerns, complaints and questions, resulting in outstanding customer service ratings.
- Documented customer interactions in internal database to maintain customer service history details.
Customer Service Supervisor
Delta Dental Of California
03.1998 - 01.2001
- Improved customer satisfaction by addressing and resolving escalated issues promptly and professionally.
- Enhanced team productivity through regular coaching, feedback, and performance evaluations.
- Streamlined workflow processes for increased efficiency in handling customer inquiries and complaints.
- Collaborated with other departments to address recurring customer concerns, improving overall service quality.
- Promoted a positive work environment through open communication channels, fostering team collaboration and high morale.
- Evaluated individual performance metrics to identify areas of improvement, providing targeted coaching to boost results.
- Monitored call center data to assess trends, proactively implementing solutions for identified issues.
- Managed escalated calls with diplomacy, successfully deescalating situations while ensuring satisfactory resolutions for both parties involved.
- Assessed team performance through regular reporting, identifying opportunities for further skill development and training initiatives.
- Coached employees through day-to-day work and complex problems.
- Responded to customer inquiries and resolved complaints to establish trust and increase satisfaction.
- Coached team members to deliver hospitable, professional service while adhering to set service models.
- Actively supported service associates by quickly responding to questions via phone and email and finding appropriate solutions to customer issues.
Claims Adjuster
Delta Dental Of California
01.1996 - 01.1998
- Improved claim resolution times by efficiently managing a caseload of 50+ claims per month.
- Achieved high customer satisfaction ratings by providing clear and timely communication throughout the claims process.
- Negotiated favorable settlements with claimants, attorneys, and other insurance carriers to minimize financial risk for the company.
- Mentored junior adjusters on best practices and industry regulations, contributing to their professional growth and development.
- Maintained compliance with state regulatory requirements through meticulous documentation and adherence to company policies.
- Evaluated coverage accurately by interpreting complex insurance policies and applying them to specific claim scenarios.
- Attended industry conferences and workshops to stay current on trends and developments within the field of claims adjusting.
- Identified potential fraud indicators early in the investigation process, protecting company assets from potential losses due to fraudulent activity.
- Conducted thorough investigations of complex insurance claims, gathering evidence and analyzing relevant documentation.
Education
No Degree - Dental Assisting
Western Career College
Sacramento, CA06.1984
Skills
- Policy Knowledge
- Dispute Resolution
- Recruitment Strategies
- Mediation Techniques
- Compliance Monitoring
- Effective Communication
- Interpersonal Skills
- Adaptability and Flexibility
- Multitasking Abilities
- Professional Demeanor
- Continuous Improvement
- Organizational Skills
- Analytical Skills
Timeline
Appeal & Grievance Coordinator
Western Health Advantage
05.2006 - 05.2007
Customer Service / Appeals & Grievance Coordinator
Blue Shield Of CA
01.2003 - 01.2005
Customer Service Supervisor
Delta Dental Of California
03.1998 - 01.2001
Claims Adjuster
Delta Dental Of California
01.1996 - 01.1998
No Degree - Dental Assisting
Western Career College
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