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, LA05-2018
Associate of Applied Science -
Baton Rouge College
Baton Rouge, LASkills
- 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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