Open to opportunities

Shatoya James

@shatoyajames

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Dedicated claims specialist with extensive experience in customer service.

United States

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What I'm looking for

I am looking for a role that values collaboration and offers growth opportunities in customer service or claims management.

I am a dedicated claims specialist with a strong background in customer service and problem-solving. Currently, I work at State Farm, where I handle complex claims, determine coverage, and negotiate settlements while ensuring exceptional customer service. My experience has equipped me with the skills to collaborate effectively with various departments to resolve issues efficiently.

Previously, I served as a Team Lead Collector II at Octane Lending, managing a portfolio and conducting collection calls to mitigate losses. My role as a Customer Care Advocate at United Health Group further honed my ability to handle escalated calls and educate customers on healthcare options. I thrive in fast-paced environments and am committed to delivering high-quality service.

Experience

Work history, roles, and key accomplishments

Claims Specialist (BCFR/Contents/Fire)

State Farm

Sep 2024 - Present (11 months)

Handles complex and unique claims, collaborating with other departments to determine coverage, liability, and damages. Issues payments per policy, negotiates settlements, and documents all claim activities while providing exceptional customer service.

Claims Management Problem Solving Negotiation Customer Service Documentation Payment Processing

Team Lead Collector II

Octane Lending

Jun 2023 - Present (2 years 2 months)

Self-managed an assigned portfolio from start to finish, accountable for performance based on targets and KPIs. Maintained delinquency and mitigated losses through outbound/inbound collection calls and skip tracing.

Collections Skip tracing KPIs Account Management Problem Solving Compliance

Customer Care Advocate SME

United Health Group

Jun 2021 - Present (4 years 2 months)

Served as a Subject Matter Expert, handling escalated calls and resolving complex customer issues. Guided and educated customers on healthcare topics, benefit plans, and navigating company websites.

Customer Service Escalation Management Subject Matter Expertise Healthcare Navigation Communication

Sr. Account Analyst/Reimbursement Analyst

UTSW Medical Center

Aug 2020 - Present (5 years)

Answered patient/client calls and resolved complex issues by reviewing accounts for discrepancies and ensuring accurate payments. Managed payment plans, updated patient demographics, and documented all account actions.

Payment Processing Data Entry

Patient Account Representative

Dallas Nephrology Associates

Apr 2019 - Present (6 years 4 months)

Managed adjudication of government, commercial, and managed care insurance, along with personal collections. Determined corrective actions, processed claims, and reconciled account ledgers.

Claims Processing Account Reconciliation Collections ESRD Coordination Of Benefits Allscripts Appeals

Appeals Associate Lead

Progenity Inc

Aug 2015 - Present (10 years)

Oversaw a team of 10, providing coaching and completing weekly QA calls. Researched and resubmitted claims, reported payer trends to management, and appealed claims via online portals.