JANOYA McPhee
Charlotte
Summary
Insurance professional with comprehensive experience in claims management, risk assessment, and customer service. Strong focus on team collaboration, problem-solving, and adapting to changing needs. Known for thorough investigations, efficient resolution of claims, and delivering reliable results under pressure. Skills include negotiation, attention to detail, and effective communication.
Overview
11
11
years of professional experience
1
1
Certification
Work History
Claims Adjuster
AllState
02.2025 - Current
- Reviewed and assessed auto claims to determine liability and coverage eligibility.
- Collaborated with repair facilities to evaluate damage estimates and negotiate repairs.
- Utilized claims management software to document case details and track progress efficiently.
- Conducted thorough investigations, gathering evidence and statements from involved parties.
- Documented all findings in concise reports.
- Established an effective system for tracking and monitoring claims from initial report to final resolution, ensuring timely updates were provided to all relevant parties.
- Enhanced customer satisfaction by efficiently managing auto claims and providing prompt resolutions.
- Utilized strong negotiation skills to settle disputed liability cases in a fair and reasonable manner, ultimately minimizing company exposure to financial risk.
Health Insurance Consultant
Tranzact
06.2024 - 01.2025
- Analyzed client needs to recommend optimal health insurance plans.
- Developed and implemented training programs for new consultants.
- Facilitated discussions between clients and insurance providers to resolve issues.
- Reviewed policy documents to ensure compliance with regulatory standards.
- Streamlined the claims process for clients by guiding them through required paperwork and simplifying communication with insurers.
- Coordinated closely with underwriting department to ensure timely processing of applications, expediting coverage initiation for clients in need.
- Established trusted relationships with medical professionals and facilities to better serve client needs during policy utilization.
- Assisted clients in navigating complex healthcare regulations, ensuring compliance with all applicable laws and guidelines.
Medicare Benefits Advisor
Assurance IQ
06.2023 - 07.2024
- Managed enrollment processes, maintaining compliance with industry regulations.
- Educated clients on Medicare options, ensuring informed decision-making.
- Conducted thorough needs assessments for each client, identifying suitable plan options based on individual requirements and financial capabilities.
- Increased overall efficiency by implementing time-saving strategies for managing daily tasks and client followups.
- Enhanced client satisfaction by providing knowledgeable guidance on Medicare plan options and enrollment procedures.
- Stayed current on industry trends and changes in regulations, enabling informed recommendations to clients seeking optimal coverage solutions.
- Consistently met or exceeded sales targets by effectively communicating the benefits of various Medicare insurance plans.
- Provided exceptional customer service by promptly addressing questions or concerns during the entire enrollment process.
- Leveraged strong problem-solving skills to address complex client inquiries and resolve issues in a timely manner.
Healthcare Customer Service Representative
United Healthcare Group
12.2022 - 06.2023
- Resolved customer inquiries regarding benefits, claims, and eligibility with accuracy and efficiency.
- Educated members on healthcare plans, services, and available resources to enhance customer experience.
- Collaborated with healthcare teams to streamline processes and improve service delivery for clients.
- Developed strong relationships with clients by providing empathetic support and understanding during challenging health situations.
- Maintained confidential patient, employee and company information in compliance with company policies and regulatory requirements.
- Maintained accurate records of customer interactions, ensuring proper documentation within the company''s database.
- Expedited service times with effective triage of incoming calls, directing patients to the correct department or resource.
- Promoted a positive work environment through active participation in team meetings and contributing ideas for organizational success.
Pharmacy Coordinator
SelectRX
09.2021 - 11.2022
- Coordinated medication distribution processes to enhance operational efficiency and accuracy.
- Implemented training programs for pharmacy staff, improving service delivery and compliance with regulations.
- Streamlined inventory management systems to reduce waste and ensure adequate stock levels.
- Developed workflows to optimize prescription processing times, increasing patient satisfaction rates.
- Collaborated with healthcare providers to enhance medication therapy management services for patients.
- Enhanced interdepartmental communication with regular updates and coordination of pharmacy services, optimizing overall healthcare delivery.
- Monitored pharmaceutical stock to determine inventory level, anticipating required medications and supplies as well as placing and expediting orders.
Client Support Coordinator
Inspiro
04.2021 - 07.2021
- Coordinated client inquiries and resolved issues to enhance customer satisfaction.
- Developed and maintained comprehensive client records using CRM software.
- Managed high-pressure situations with clients, maintaining a calm demeanor and professional attitude throughout the resolution process.
- Responded to all client inquiries and asked appropriate questions to facilitate resolution.
- Delivered outstanding service to clients to not only maintain but to extend relationship for future business opportunities.
Clinical Support Specialist
Abbott Laboratories
09.2020 - 03.2021
- Maintained up-to-date knowledge on industry advancements, continually improving the level of care provided to patients.
- Improved customer retention with empathetic and efficient handling of support cases.
- Assisted nursing staff with feeding assistance when needed, ensuring that patients received adequate nutrition support during their hospital stay.
- Collaborated with dietitians to develop customized meal plans for patients, ensuring optimal nutritional support during their recovery process.
- Provided nutritional support for patients requiring assistance with meals or feeding tubes while ensuring proper dietary restrictions were followed.
Patient Account Representative
Tallahassee Memorial Hospital
02.2017 - 08.2020
- Managed patient billing inquiries, ensuring timely resolution and satisfaction.
- Collaborated with healthcare providers to verify insurance eligibility and benefits.
- Reviewed and processed patient accounts for accuracy and completeness.
- Educated patients on financial responsibilities and payment options available.
- Worked with outside entities to resolve issues with billing, claims, and payments.
Administrative Assistant
St Lucie County Public Schools
01.2015 - 01.2017
- Assisted with scheduling and coordinating meetings for faculty and staff.
- Managed incoming communications, including phone calls and emails, ensuring timely responses.
- Maintained accurate records of student attendance and performance data in school databases.
- Supported administrative tasks by preparing documents and reports for school administration.
Education
Associate of Arts - Business Administration And Management
Valencia College
Orlando, FL05-2026
High School Diploma -
Fort Pierce Westwood Highschool
Fort Pierce, Florida05-2017
Skills
- Critical thinking
- Claims investigation
- Active listening
- Highly motivated
- Attention to detail
- Empathy and patience
- Multitasking and organization
- Verbal and written communication
- Conflict resolution
- Ethical judgment
- ICD-10 coding
- HIPAA compliance awareness
- Strong analytical skills
- Data entry efficiency
- Healthcare billing
- Insurance claims processing
- Medical terminology
- Insurance claims management
- Computer skills
- Reliability
Certification
- Licensed 2-15 Health & Life, Annuity
- Licensed 2-20 All Lines Adjuster
Timeline
Claims Adjuster
AllState
02.2025 - Current
Health Insurance Consultant
Tranzact
06.2024 - 01.2025
Medicare Benefits Advisor
Assurance IQ
06.2023 - 07.2024
Healthcare Customer Service Representative
United Healthcare Group
12.2022 - 06.2023
Pharmacy Coordinator
SelectRX
09.2021 - 11.2022
Client Support Coordinator
Inspiro
04.2021 - 07.2021
Clinical Support Specialist
Abbott Laboratories
09.2020 - 03.2021
Patient Account Representative
Tallahassee Memorial Hospital
02.2017 - 08.2020
Administrative Assistant
St Lucie County Public Schools
01.2015 - 01.2017
Associate of Arts - Business Administration And Management
Valencia College
High School Diploma -
Fort Pierce Westwood Highschool