Alexus Newton
Jacksonville,Florida
Summary
To obtain a position as a team-player in a people-oriented organization where I can maximize customer service and analytical skills in a challenging environment to achieve the corporate goals.
Overview
13
13
years of professional experience
Work History
Claims Examiner
AmeriHealth Caritas
10.2023 - Current
- Complies with all internal processes and procedures to ensure activities are handled in accordance with departmental and company policies and procedures.
- Review, research, analyze, and process complex healthcare claims by navigating multiple computer systems and platforms and accurately capturing the data/information for processing (e.g. verify pricing, prior authorizations, applicable benefits).
- Escalates claim and/or system issues to Team Lead or Supervisor.
- Creates and supports a professional environment which fosters teamwork, cooperation, respect and diversity.
- Meet department quality and production requirements
- Process 150-200 claims daily
Financial Associate 2
Fidelity Investments
08.2021 - 09.2023
- Ability to establish rapport and relationships through effective communication.
- Listening and compassion skills to support the challenges of our diverse customers.
- Adaptability and flexibility to succeed in various work environments (i.e., balancing working
- from office and home, overtime, etc.)
- Handle a variety of situations and conversations driving towards a resolution suitable for all.
- Self-motivated teammate with strong social skills who bring energy and passion to the team.
- Collaborated with cross-functional teams to develop comprehensive financial models for business forecasting.
Support Analyst
Mphasis (JPMorgan Chase Bank)
07.2020 - 05.2021
- Monitor work queue daily and perform task according to SLA requirements
- Verify loan notes on the file and check loan status
- Status / update the file in provided systems
- Review different documents to make sure they comply and are accurate according to guidelines
- Order and follow-up on Homeowner's Insurance, Verifications of Employment and Payoffs
- Review Insurance, Verification and Payoffs that come in to ensure all information is provided per requirements.
Reconsideration Analyst
C2C Innovative Solutions
05.2017 - 06.2020
- Coordinates the delivery of re-determination files and reconsideration decisions from and to the external entities
- Builds a reconsideration case file from evidence submitted, received, and analyzes each case to ensure it meets the requirements for a valid reconsideration request as mandated by Centers for Medicare and Medicaid Services (CMS) or other customer entities
- Inputs appropriate data regarding reconsiderations cases into the applicable required systems
- Submits requests for re-determination files and completed reconsideration decisions to relevant entities
- Responds to reconsideration requests from appellants
- Coordinates with clerical/mailroom staff to receive new casework, archive completed casework, obtain archived files from storage and re-route misrouted appeals requests
- Identifies any suspected instances of fraud and/or abuse and immediately informs management of such issues
- Identifies and resolves problems or refers issues appropriately
- Adapts to the needs of internal and external customers
- Assures compliance with regulatory, contractual, and accreditation entities
- Maintains strict adherence to confidentiality and security policies and procedures.
Telesales (Florida Blue)
Capital Staffing
09.2016 - 04.2017
- Licensed to sell health insurance ( 0240- Health license )
- Outbound and inbound calls
- Collaborate with customers to find a health insurance plan that meet prospects needs and/or budget
- Proceed through the evaluation process with clients helping them qualify for premium tax credit
- Build customer relationships
- Achieve high sales percentages with consultative, value-focused customer service.
Customer Service & Sales Associate
Convergys
03.2016 - 07.2016
- Outstanding customer service and sales skills; ability to resolve complex customer issues involving multiple accounts
- Excellent listening skills with the ability to acknowledge the issue, display empathy and concern for the problem, analyze the root cause and assure a resolution
- Ability to multi-task
- Strong oral and written communication skills
- Accomplished computer skills: ability to navigate multiple screens and programs
- Flexibility/Adaptability
- Problem solving skills, ability to think outside of the box
- Prepare complete and accurate work and update customer file
- Use decision support tools to respond to common customer work/ service order inquires and requests
- Initiate and ensure repair and maintenance work, if required
- Maintain basic knowledge of client products/services.
Customer Service
Communities in Schools (Jacksonville, FL)
09.2011 - 03.2016
- Receive and direct visitors
- Answer telephone calls, file, data entry
- Perform a variety of research functions
- Contribute to team effort by accomplishing related results as needed
- Provide information by answering questions and request
- Update knowledge by participating in educational opportunities
- Serve customers by backing-up receptionist, answering questions.
Education
Associates in Arts Degree (Health Studies) -
Florida State College at Jacksonville
01.2015
High school Diploma -
First Coast High School
Jacksonville, FL01.2011
Skills
- Analytical skills
- Communication skills
- Detail oriented
- Interpersonal skills
- Claims Processing
- Data Verification
- Record Management
Timeline
Claims Examiner
AmeriHealth Caritas
10.2023 - Current
Financial Associate 2
Fidelity Investments
08.2021 - 09.2023
Support Analyst
Mphasis (JPMorgan Chase Bank)
07.2020 - 05.2021
Reconsideration Analyst
C2C Innovative Solutions
05.2017 - 06.2020
Telesales (Florida Blue)
Capital Staffing
09.2016 - 04.2017
Customer Service & Sales Associate
Convergys
03.2016 - 07.2016
Customer Service
Communities in Schools (Jacksonville, FL)
09.2011 - 03.2016
Associates in Arts Degree (Health Studies) -
Florida State College at Jacksonville
High school Diploma -
First Coast High School