Afrah Fawmey Desmond
Richmond,VA
Summary
Knowledgeable and dedicated customer service professional with extensive experience in Health insurance industry. Solid team player with outgoing, positive demeanor and proven skills in establishing rapport with clients. Motivated to maintain customer satisfaction and contribute to company success. Specialize in quality, speed and process optimization. Articulate, energetic and results-oriented with exemplary passion for developing relationships, cultivating partnerships and growing businesses. Personable Member Service Representative offering more than 10 years of experience resolving account and service concerns for customers. Smoothly uncovers and solves challenges while promoting company products and maintaining loyal, satisfied customers. Focused on surpassing expectations and driving team success.
Overview
18
18
years of professional experience
Work History
Provider Pay Reconsideration Analyst 1
Anthem Inc (Elevance Health)
Glen Allen, VA
05.2023 - Current
- Reviewed, investigated and processed medical claims for accuracy and completeness.
- Interpreted and applied contractual language in the adjudication of health care claims.
- Analyzed claim data to identify trends or patterns of abuse or fraud.
- Ensured timely resolution of provider inquiries related to their claims.
- Implemented quality control measures to improve overall claim processing efficiency.
- Evaluated provider payments for accuracy and adherence to applicable state laws.
- Monitored status of pending claims on a daily basis and followed up as needed.
- Coordinated with providers regarding denied and incomplete claims requiring additional information.
- Maintained detailed records of all activities related to the administration of health care benefits.
- Collaborated with other departments on projects that involved the review or analysis of claims data.
Claims Representative Tier 3
Anthem Inc (Elevance Health)
Glen Allen, VA
09.2021 - 05.2023
- Collaborated with other departments to resolve billing disputes or address customer concerns quickly.
- Documented changes in claim statuses using specialized software systems.
- Conducted research into medical terminology related to healthcare claims processing activities.
- Developed strategies to reduce the number of denied or delayed claims within assigned portfolio.
- Analyzed trends in claim denials or delays to identify areas for improvement within the organization.
- Ensured timely submission of required documentation from claimants prior to approval of payment.
- Adhered to strict guidelines pertaining to confidentiality while handling sensitive personal information.
- Reviewed and verified claim information to ensure accuracy of data and compliance with established policies.
Customer Service Representative 2
Anthem,Inc
Richmond, VA
09.2019 - 09.2021
- Maintained customer satisfaction with forward-thinking strategies focused on addressing customer needs and resolving concerns
- Provided primary customer support to internal and external customers
- Operates a PC/image station to obtain and extract information, documents information, activities, and changes in the database
- Guide providers with their healthcare needs by explaining benefits, solving claim concerns, helping find a doctor via telephone calls, online chats or e-mails
- Implemented improvements in manual and electronic billing procedures
Claim Specialist Manager
Netelex
Ashburn, VA
01.2010 - 12.2013
- Was responsible for reviewing a client's claim in order to determine whether or not they are covered under a policy and to evaluate the extent of a settlement that the insurance company must pay
- Reviewed new files to determine current status of claim and to develop plan of action
- Led projects and analyzed data to identify opportunities for improvement
- Identified issues, analyzed information and provided solutions to problems
- Maintained excellent attendance record, consistently arriving to work on time
- Supervised employees and assessed performances to determine training needs and define accurate plans for decreasing process lags
- Introduced higher standards for customer service and increased efficiency by streamlining operations
- Helping to develop and implement a customer service policy for an entire organization
- Finding ways to measure customer satisfaction and improve services
- Handling face-to-face enquiries from customers
Customer Service Manager
IIM Lanka
Colombo, Sri Lanka
01.2007 - 01.2010
Education
Associate of Science - Nursing
J Sargeant Reynolds Community College
Richmond, VA04.2023
Associate of Arts - Computer And Information Sciences
J Sargeant Reynolds Community College
Richmond, VA09.2021
Associate of Science - Prenursing Studies
J Sargeant Reynolds Community College
Richmond, VA06.2019
Associate of Science - Medical Billing And Coding Specialist
US Career Institute
Fort Collins, CO09.2016
Skills
- Calm and Professional Under Pressure
- Courteous with Strong Service Mindset
- Data Entry and Maintenance
- Efficient and Detail-Oriented
- CRM Software
- Customer Data Confidentiality
- Creative Problem Solving
- Responding to Difficult Customers
- Upselling Products and Services
- Customer Retention Strategies
- Multitasking and Prioritization
- Workflow Analysis
- Process enhancement
- Documentation And Reporting
- Quantitative Research
Timeline
Provider Pay Reconsideration Analyst 1
Anthem Inc (Elevance Health)
05.2023 - Current
Claims Representative Tier 3
Anthem Inc (Elevance Health)
09.2021 - 05.2023
Customer Service Representative 2
Anthem,Inc
09.2019 - 09.2021
Claim Specialist Manager
Netelex
01.2010 - 12.2013
Customer Service Manager
IIM Lanka
01.2007 - 01.2010
Associate of Science - Nursing
J Sargeant Reynolds Community College
Associate of Arts - Computer And Information Sciences
J Sargeant Reynolds Community College
Associate of Science - Prenursing Studies
J Sargeant Reynolds Community College
Associate of Science - Medical Billing And Coding Specialist
US Career Institute
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