Amber Moore
Jackson
Summary
Skilled claims processing professional with extensive experience in reviewing and validating insurance claims. Strong focus on accuracy, problem-solving, and effective communication. Known for collaborative approach and adaptability to changing needs. Proficient in claims software, data entry, and customer service. Recognized for reliability and achieving results in team environments.
Overview
11
11
years of professional experience
1
1
Certification
Work History
ADMINISTRATIVE ASSISTANT
TriStar Skyline Medical Center
Nashville, TN
08.2023 - Current
- Coordinate presentations, enhancing team efficiency and communication.
- Generate detailed reports, supporting informed decision-making.
- Manage multiple projects, ensuring timely completion and quality.
- Prepare invoices, maintaining accurate financial records.
- Resolve administrative issues, improving operational workflows.
Claims Processor
Blue Cross and Blue Shield
Nashville, TN
05.2020 - 08.2023
- Review and process 50 insurance claims daily for accuracy and completeness.
- Verify coverage, eligibility, and policy limits before claim approval.
- Investigate discrepancies and request additional documentation when needed.
- Apply appropriate coding and payment adjustments according to guidelines.
- Ensure compliance with federal, state, and company regulations.
- Maintain detailed and accurate records in claims management systems.
- Communicate with policyholders, providers, and internal departments to resolve claim issues.
- Meet or exceed productivity and accuracy benchmarks.
Healthcare Customer Service Representative
Aetna Medicaid
Jackson, TN
02.2017 - 03.2020
- Respond to 100 inbound calls daily regarding benefits, claims, billing, and coverage questions.
- Verify insurance eligibility and benefits using MHK, AS400 and People Safe.
- Assist patients with appointment scheduling and referral coordination.
- Resolve complex customer concerns while maintaining professionalism and empathy.
- Document all interactions accurately in EMR/CRM systems.
- Ensure full compliance with HIPAA and company policies.
- Collaborate with billing, clinical, and administrative teams to resolve discrepancies.
TECHNICAL SUPPORT REPRESENTATIVE
Elavon
Knoxville, TN
09.2014 - 01.2017
- Managed customer accounts, ensuring accurate data entry and account maintenance.
- Resolved service issues by analyzing problems and implementing effective solutions.
- Processed financial adjustments, maintaining account accuracy and reliability.
- Suggested new products by analyzing customer needs, enhancing service offerings.
- Generated detailed reports from customer data, supporting informed decision-making.
Education
High School or Equivalent - Nursing
Hunterslane Highschool
Nashville, TN01.2013
Skills
- Administrative support
- Microsoft Word
- Time management
- Customer and client relations
Technical Support
- Computer proficiency
- Filing
- Communication
- Organizational
- Claims review
Certification
- Driver's License
- ServSafe Alcohol
- ServSafe Alcohol: December 2019 to December 2025
Timeline
ADMINISTRATIVE ASSISTANT
TriStar Skyline Medical Center
08.2023 - Current
Claims Processor
Blue Cross and Blue Shield
05.2020 - 08.2023
Healthcare Customer Service Representative
Aetna Medicaid
02.2017 - 03.2020
TECHNICAL SUPPORT REPRESENTATIVE
Elavon
09.2014 - 01.2017
High School or Equivalent - Nursing
Hunterslane Highschool