Paris Jefferson

Claims Processor at Allstate (2023-10 – 2025)

Email/chat to customers/internal employees identifying customer issues, providing solutions, conversing in a polite and professional manner while performing data entry
Analyzing and processing claims through well-developed action plans to an appropriate and timely resolution by investigating and gathering information to determine the exposure on the claim
Negotiating settlement of claims within designated authority
Communicating claim activity and processing with the claimant and the client
Reporting claims to the excess carrier and responding to requests of directions in a professional and timely manner
Ensure that all assigned claims are resolved in a timely manner, accurately and resolved fairly
Communicate and connect with policyholders, agents, engineers, and service providers on a daily basis
Calculate benefits payable under the policy and either make payments or decline payments on claims. Enter claim payout information via Microsoft excel
Evaluate and apply the homeowner insurance contract as it pertains to claims assigned for resolution
Understand, adjust and use loss damage estimates to accurately determine amounts payable and to collaborate with public adjusters, attorneys, contractors and other related service providers
Create and maintain a diary system in the electronic claims management system and related applications

Scheduling Specialist at Opendoor (2022-10 – 2023)

Actively review excel spreadsheet with listed/renovation homes to schedule cleaning or landscaping work for property
Work with our customers, our vendors, and various Opendoor internal teams to accomplish task
Support the market Home Operations Team in establishing a culture that is conducive to Opendoor’s core principles and a superior customer experience
Maintain a high level of customer care while developing a clear and thorough assessment of home condition
Create repair and renovation scopes for local vendors adhering to quality and pricing standards
Manage the execution of repair and renovation scopes on time, on budget, and at or exceeding our quality standards
Interacting with and working within a scheduling system to coordinate work
Finalize schedules for preparation of home for listing including security system and sign set up
Quickly adapt to evolving situations and priorities
Chat and style with direct contact to customers via chat, video and new virtual platforms per appt

Tech Support Specialist at Wells Fargo (2022-01 – 2022-09)

Analyze, test, and troubleshoot network systems
Respond to customer tickets using Zendesk and entering updates via Microsoft excel and update charts
Maintain networks to ensure they run smoothly
Implement, configure, update, and maintain IT systems
Administer, test, and implement computer databases
Identify and resolve database performance issues
Provide technical advice and support
Develop and administer training programs
Create help guides and other technical documentation
Promote technology products or services
Provides technical support and maintenance for organization computer systems, networks, and programs
Help develop training programs and create technical documentation with step by step guides
Developing application designs and web pages
Providing customer support for programs and applications via remote computer access

Intake Specialist at Illnois Housing Authority (2021-02 – 2021-12)

Verify housing application tenant rent information and landlord information.
Keep track of application processing per day via Microsoft excel.
Communicate with clients to obtain necessary documents
Record the disposition and location of all client files currently leased and/or terminated
Assist with document management of files in preparation for annual re-exam, interim, re-determinations, audits, and special requests
Recommend policies and procedures for the file room, as well as, making changes when necessary
Coordinate with staff in distributing files as needed
Ensure documents are scanned correctly to satisfy overall quality requirements for legibility
Familiarity with the client system and client forms ensures documents are scanned to the correct department and indexed under the right document type
Perform other duties as assigned
Determine the type of help that their clients need
Work with social workers and healthcare professionals to develop treatment plans

Health Program Representative at Anthem (2018-10 – 2021-02)

Responsible for providing initial contact between distinct Care Management programs and specific identified members
Strong attention to detail with patient information when keying in authorization info via Microsoft excel
handles inbound/outbound enrollment and engagement calls with eligible members to gather and record appropriate member information in accordance with policies and procedures
Responsible for reviewing medical claims and coding accuracy( CPT, HCPCS and ICD-9 codes and modifiers policies, and procedures to ensure that an organization is running an efficient and liability-free operation
Responsible for reviewing patient medical records and determine whether a requested healthcare service is medically necessary to justify prior authorization from insurance company
Ensuring proper coverage and billing by gathering and submitting required documentation to support the prior authorization request
Responsible for obtaining and processing all prior authorization requests, coordinating phone calls
Responsible for keying/entering member descriptions and benefit information collected via phone/email
Added and updated coverage notes for patient Benefits State Coverage
Encourages members to participate in the Care Management programs by providing information about the program, outlining program features/value and explaining available services
Records call details and utilize call scripts as needed based on client requirements for Medicare Part D enrollment

Onboarding Specialist at Harris Stowe State University (2011-08 – 2013-05)

Greet students and parents as they enter the admissions office
Determine the nature of the visit and direct students to the appropriate person
Provide direct student services and works collaboratively with other offices to support admissions, registration and related activities
Understand Admissions, Registrar, Testing and Academic Advising processes, as well as a basic understanding of other departments and areas around campus in order to serve as a campus resource for current and prospective students
Assist with orientation and campus visit events
Assist with continuing assessment and evaluation of admissions processes
Provide suggestions to enhance the delivery of enrollment management information provided in person, over the telephone, and via the internet
Assist students in completing admissions and enrollment applications, forms, and other transactions
I Answer the phone line ensuring all incoming calls are triaged and transferred to appropriate individuals and the caller's needs are met. Take and deliver detailed messages in a timely manner
Assist in distribution of transcripts, verification of enrollments and other requested academic records
Assist students with onboarding papers for class enrollment etc

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