Aaliyah Adams
Cypress,Texas
Summary
Friendly Insurance Verification Specialist promoting a background in keeping sensitive patient data confidential while maintaining knowledge of Medicaid and private policy benefits. Possessing great relationship building and communication skills. Looking to tackle new challenges with a company that values dynamic skills and a strong work ethic.
Driven [Customer service] successful at delivering vital clerical support to internal teams and customers. Demonstrated abilities in analytical problem solving and talent for boosting operational efficiency.
Experienced with office administration and clerical tasks. Utilizes organizational skills and attention to detail to manage schedules and documentation effectively. Strong understanding of administrative procedures and team support.
Overview
9
9
years of professional experience
Work History
Administrative Clerk
Rady's Children's Hospital
07.2024 - 12.2024
- Entered data into system and updated customer contacts with information to keep records current.
- Safeguarded sensitive information by maintaining strict confidentiality protocols when handling personnel files or company documentation.
- Input data and processed system change to generate accurate reports.
- Communicated with customers via phone and email to confirm deliveries and respond to inquiries.
- Balanced multiple roles to accomplish diverse tasks and make larger impact to organization.
- Helped maintain a positive office atmosphere with proactive conflict resolution and team-building efforts.
Claims Representative
Diversified system
11.2021 - 04.2024
- Provided quality customer service to assigned, insured and claimants throughout claims process to deliver timely service to customers
- Verified details with policyholders and requested additional information
- Delivered quality customer service to assigned, insured and claimants throughout entire claims lifecycle to promote service times
- Reviewed documentation and accounts to gain full picture
- Assisted claimants, providers and clients with problems or questions regarding claims
- Worked productively in fast-moving work environment to process large volumes of claims.
- Followed up with customers on unresolved issues.
Customer Service Representative
HealthPlanOne
09.2020 - 10.2021
- Answered customer telephone calls promptly to avoid on-hold wait times
- Answered constant flow of customer calls with minimal wait times
- Collected customer feedback and made process changes to exceed customer satisfaction goals
- Delivered excellent customer-service, resulting in consistent [90] % customer satisfaction rating
- Handled over [50+] calls per shift signing up new customers, retrieving customer data, presenting relevant product information and cancelling services
- Provided assistance to clients
- Answered phone and assisted clients and customers with changes
Medical Claims Representative
Diversicare Health Care
09.2018 - 07.2020
- Maintained knowledge of benefits claim processing, claims principles, medical terminology and procedures and HIPAA regulations
- Managed large volume of medical claims on daily basis
- Paid or denied medical claims based upon established claims processing criteria
- Responded to correspondence from insurance companies
- Used administrative guidelines as resource or to answer questions when processing medical claims
- Reviewed provider coding information to report services
Participant Services Associate
Ascensus
11.2015 - 09.2018
- Provide expertise or general claims support by reviewing
- Researching
- Investigating
- Negotiating
- Processing and adjusting claims
- Answering questions regarding pre-tax spending accounts, such as health and dependent care Flexible
- Spending Accounts (FSA), as well as Commuter Benefit Services, including transit and parking programs
- Health Savings Accounts, & Health Reimbursement Arrangements
- Analytical skills in reviewing and interpreting policy coverage and claims status
Education
Na -
Houston community College
Houston, TXHigh School Diploma - undefined
Klein Forest High School
Houston, TX05.2018
Skills
- Claims
- Interpersonal Communication
- Decision Making
- Documentation Research
- Policy Knowledge
- Claims Investigation
- Database Management
- Data Analysis
- Insurance Claims Review
- Small Claims Payouts
- Customer Service
- Insurance Claim Forms Review
- Microsoft Office
- Payment and Investigation Escalations
- ICD-10 Coding
- Computer Skills
- HIPAA Compliance
- Problem-Solving
- OSHA Compliance
- Data Entry Software
- Equipment Troubleshooting and Maintenance
- Epic Systems
- Customer service
- Typing
- JavaScript Expert
- Good Work Ethic
- Zendesk
- Microsoft outlook
- Information verification
- Communication skills
- Fraud
- HRIS (5) years
- Attention to detail
- Clerical support
- Maintaining confidentiality
- Verbal and written communication
Timeline
Administrative Clerk
Rady's Children's Hospital
07.2024 - 12.2024
Claims Representative
Diversified system
11.2021 - 04.2024
Customer Service Representative
HealthPlanOne
09.2020 - 10.2021
Medical Claims Representative
Diversicare Health Care
09.2018 - 07.2020
Participant Services Associate
Ascensus
11.2015 - 09.2018
High School Diploma - undefined
Klein Forest High School
Na -
Houston community College
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