Summary
Overview
Work History
Education
Skills
Timeline
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Alaya Stove

Houston,TX

Summary

Recent graduate with excellent research, technical and problem-solving skills. Detail-oriented and able to learn new concepts quickly. Passionate and professional Representative leads outreach efforts, strategic direction and day-to-day function management. Proven talent at building relationships and influencing others to gain support and commitment. Excellent presentation and communication skills and comfort working in fast-paced environment. Organized Coordinator focused on boosting customer satisfaction and service quality. Familiar with documentation, reporting and compliance requirements. Skilled in managing employee documentation and maintaining files and records.

Overview

5
5
years of professional experience

Work History

Claims Processing Coordinator

NTT DATA – Remote
03.2023 - Current
  • Entered claim information into the company's claims processing system with an accuracy rate consistently at 100%
  • Collaborated with internal teams to investigate and resolve issues related to claims processing, ensuring timely resolution
  • Maintained records and documentation of claims processing activities, adhering to company standards and regulatory requirements
  • Supported data entry tasks related to claims data management, including updating statuses and ensuring proper documentation, contributing to efficient operations.
  • Analyzed data to identify trends in customer behavior and preferences.
  • Resolved customer complaints in a timely manner while upholding company standards.
  • Conducted interviews with potential candidates for open positions within the organization.

Claims Benefit Specialist

Broadpath Healthcare Solutions – Remote
04.2021 - 03.2023
  • Analyzes and approves routine claims that cannot be auto adjudicated.
  • Applies medical necessity guidelines, determine coverage, complete eligibility verification, identify discrepancies, and applies all cost containment measures to assist in the claim adjudication process.
  • Proofs claim or referral submission to determine, review, or apply appropriate guidelines, coding, member identification processes, provider selection processes, claim coding, including procedure, diagnosis and pre-coding requirements.
  • May facilitate training when considered topic subject matter expert.
  • In accordance with prescribed operational guidelines, manages claims on desk, route/queues, and ECHS within specified turn-around-time parameters (Electronic Correspondence Handling System-system used to process correspondence that is scanned in the system by a vendor).
    - Utilizes all applicable system functions available ensuring accurate and timely claim processing

Customer/Technical Customer Service Representative

Remote Wfh
01.2019 - 01.2021
  • Provided excellent customer service support by addressing inquiries and resolving issues with an accuracy rate consistently exceeding 97%
  • Collaborated with internal teams to investigate and resolve customer concerns or complaints, ensuring prompt resolution and customer satisfaction
  • Maintained detailed records of customer interactions and transactions, adhering to company policies and procedures
  • Demonstrated strong communication skills in conveying updates and information to customers, ensuring transparency and clarity.
  • Provided technical assistance to customers over the phone and through email.
  • Resolved customer inquiries in a timely manner, ensuring customer satisfaction.
  • Answered customer questions regarding system functionality and usage.
  • Assisted customers in troubleshooting hardware and software issues.
  • Created detailed documentation for each customer interaction to maintain accurate records of service provided.
  • Developed an understanding of customer needs by actively listening to their requests and communicating solutions effectively.
  • Monitored incoming support tickets, responding quickly when needed.
  • Tracked progress on open cases, escalating more complex issues when appropriate.
  • Managed multiple projects simultaneously while meeting all deadlines.
  • Adhered to established policies and procedures related to customer service operations.

Education

High School Diploma -

Terrebonne High School
Houma, LA
05-2018

Associate of Applied Science -

Baton Rouge College
Baton Rouge, LA

Skills

  • Consulting
  • Business Administration
  • Data Entry
  • Information Collection
  • Medical Terminology
  • Schedule Coordination
  • CRM Software
  • MS Office
  • Customer Service
  • Patient Scheduling
  • Filing and data archiving
  • Verifying data accuracy

Timeline

Claims Processing Coordinator

NTT DATA – Remote
03.2023 - Current

Claims Benefit Specialist

Broadpath Healthcare Solutions – Remote
04.2021 - 03.2023

Customer/Technical Customer Service Representative

Remote Wfh
01.2019 - 01.2021

High School Diploma -

Terrebonne High School

Associate of Applied Science -

Baton Rouge College

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Alaya Stove