Acura Joyner
Tampa,FL
Summary
Innovative professional with 5+ years of experience providing excellent support to clients while building rapport. Well versed in Customer Service, Claims Processing and data analyzing. Adept in implementing problem-solving techniques for customer complaints and handling high call volume. Motivated to maintain customer satisfaction and contribute to company success. Specialize in quality, speed and process optimization.
Overview
9
9
years of professional experience
Work History
Claims Associate
Kforce
02.2020 - Current
- Affirmed or denied coverage fairly based on thorough investigations.
- Worked with claims adjusters and examiners to expedite processing in alignment with procedures.
- Examined reports, accounts and evidence to determine integrity and accuracy of information.
- Evaluated and settled complex insurance claims in strict timeframes.
- Proposed settlements for uncomplicated issues to resolve claims.
Claims Processing Specialist
CareCentrix
11.2017 - 01.2020
- Collaborated with claims department and industry anti-fraud organizations to resolve claims.
- Followed up with customers on unresolved Claims issues and analyzed information gathered by investigations to report findings and recommendations
- Interviewed agents and claimants to correct errors or omissions and investigate questionable claims.
- Prepared insurance claim forms or related documents and reviewed for completeness.
- Assured timely verification of insurance benefits prior to patient procedures or appointments.
Claims & Customer Service Representative
HealthPlan Services
06.2015 - 11.2017
- Answered customer telephone calls promptly to avoid on-hold wait times and Offered advice and assistance to customers, paying attention to special needs or wants.
- Interviewed policyholders to verify information and obtain additional details and followed up with customers on unresolved claim issues.
- Checked level and type of coverage and evaluated contracts.
- Evaluated accuracy and quality of data entered into agency management system and processed and recorded new policies and claims.
- Offered friendly and efficient service to all customers, Proposed settlements for uncomplicated issues to resolve claims.
- Elevated client satisfaction levels through proactive communication of claim status updates and prompt follow-ups on inquiries
Education
High School Diploma -
Blake High School
Tampa, FL 08.2024 - 06.2024
Skills
Customer Service Excellence
Interdepartmental Coordination
Validation of Discrepancies
Claims Review
First Call Resolution
Eligibility Determinations
Transactions Reconciliation
Claims Processing
Data Entry & Quality Assurance
Customer Service Excellence
Timeline
High School Diploma -
Blake High School
08.2024 - 06.2024
Claims Associate
Kforce
02.2020 - Current
Claims Processing Specialist
CareCentrix
11.2017 - 01.2020
Claims & Customer Service Representative
HealthPlan Services
06.2015 - 11.2017