Aaliyah KYLES
Mobile
Summary
Professional with focus on claims evaluation and resolution. Adept at analyzing complex information, negotiating settlements, and ensuring compliance with regulations. Known for strong teamwork and adaptability, driving results in fast-paced environments. Skilled in customer communication, conflict resolution, and decision-making.
Overview
10
10
years of professional experience
Work History
Claims Adjuster
Pilot
09.2022 - Current
- Enhanced claim processing efficiency by streamlining workflows and implementing best practices.
- Reduced turnaround time for claim settlements by prioritizing tasks and managing deadlines effectively.
- Improved customer satisfaction by providing timely and accurate information on claim status and resolution.
- Collaborated with cross-functional teams to expedite complex claims investigations and resolutions.
- Minimized financial losses by identifying fraudulent claims through thorough analysis and investigation.
- Negotiated favorable settlements with claimants, resulting in cost savings for the company.
- Maintained compliance with industry regulations by adhering to established procedures and guidelines in claims handling.
- Developed strong relationships with clients, facilitating trust and open communication during the claims process.
- 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.
AR Specialist
Rotech Healthcare
08.2018 - 09.2022
- Assists with updating respiratory grid
- Clears previous day's route and checks all paperwork for accuracy and completeness
- Communicates with patients/clients and referral sources both verbally and in writing to ensure patient/client questions and concerns are processed in a timely manner
- Completes SOPs/CMNs and documents on tracking log
- Complies with all applicable company policies and procedures to meet JCAHO and company standards
- Coordinates all patient information, processes paperwork, including preparation of file for Billing Department, and completes batch reports for UPS deliveries
- Maintains referral log
- Monitors office supplies
- Prepares deposit for location on a weekly basis
- Prepares invoices for next day routes
- Processes paperwork-confirms tickets, inputs new patient set-ups, and assembles charts
- Provides service for all retail/walk-in equipment requests
- Provides technical assistance to customers
- Verifies Medicare, Medicaid, and private insurance coverage information
- Works with outside agencies to resolve customer issues
- May be required to cover on call, drive a company vehicle and make deliveries to patient's homes
- Predictable and regular attendance (arrive to work on time)
- Ability to work cooperatively with others
- Deal politely with patients and referral sources
- Manage several tasks at once
- Performs other duties as assigned
Customer Service Representative
Alorica
05.2016 - 08.2018
- Enhanced customer satisfaction by promptly addressing concerns and providing accurate information.
- Streamlined call center processes for improved efficiency and reduced wait times.
- Resolved customer complaints with empathy, resulting in increased loyalty and repeat business.
- Assisted customers in navigating company website and placing online orders, improving overall user experience.
- Maintained detailed records of customer interactions, ensuring proper follow-up and resolution of issues.
- Exceeded performance metrics consistently, earning recognition as a top performer within the team.
- Answered constant flow of customer calls with minimal wait times.
- Actively listened to customers, handled concerns quickly and escalated major issues to supervisor.
- Handled customer inquiries and suggestions courteously and professionally.
- Delivered exceptional customer service to every customer by leveraging extensive knowledge of products and services and creating welcoming, positive experiences.
- Met customer call guidelines for service levels, handle time and productivity.
- Responded to customer requests, offering excellent support and tailored recommendations to address needs.
- Provided excellent customer care by responding to requests, assisting with product selection and handling ordering functions.
- Promoted available products and services to customers during service, account management, and order calls.
- Answered customer telephone calls promptly to avoid on-hold wait Times
Education
Associate of Arts - General Studies
Bishop State Community College
Mobile, AL08.2018
Skills
- Claims processing
- Settlement negotiation
- Casualty and property loss
- Legal compliance
- Accounts receivable management
- Bookkeeping
- Payment posting
- AR aging reports
- Write-off procedures
- Claims management
- Insurance benefits verification
- Call center customer service
- Call control
Timeline
Claims Adjuster
Pilot
09.2022 - Current
AR Specialist
Rotech Healthcare
08.2018 - 09.2022
Customer Service Representative
Alorica
05.2016 - 08.2018
Associate of Arts - General Studies
Bishop State Community College