ANTOAN SIMPSON
St. Petersburg,FL
Summary
Accomplished E&I PRC Claims Adjuster with a proven track record at United Healthcare, adept in Microsoft Office and demonstrating exceptional attention to detail. Excelled in claims processing and customer service, significantly enhancing claims accuracy and compliance. Skilled in leading teams to meet departmental targets, showcasing an unparalleled commitment to efficiency and client satisfaction.
Overview
14
14
years of professional experience
Work History
E&I PRC Claims Adjuster
United Healthcare
01.2023 - Current
- Resolved inquiries and issues related to claims eligibility from start to finish.
- Analyzed medical authorizations for accuracy.
- Researched policy information to ensure accuracy and compliance.
Provider Service Advocate
United Health care
05.2021 - 12.2022
- Addressed questions concerning member eligibility and benefits efficiently.
- Managed provider network, demographics, and contracts.
- Conducted extensive reviews of medical authorizations and notifications to ensure adherence to guidelines.
Customer Care Representative
Apex Systems
10.2020 - 02.2021
- Handled issuing information for health savings accounts; accurate balance, transaction verification.
- Updated address and email information for account holders.
- Enhanced understanding of using health savings account in conjunction with investment accounts.
Medical Records Specialists
Metro Inclusive Health
06.2017 - 04.2019
- Handled incoming requests ensuring accurate scanning of medical information.
- Enhanced accuracy of insurance verification.
- Performed outbound reminder calls for next-day appointment confirmations.
Service Advocate V
Florida Blue
07.2011 - 07.2016
- Handled calls to ensure prompt resolution for customers.
- Maintained consistency in handling various aspects of insurance processing.
- Handled complex customer issues for accurate resolutions.
- Managed group of advocates to uphold departmental targets.
Education
High School Diploma -
King High
Tampa, FLSome College (No Degree) -
SPC
St. Petersburg, FLSkills
- Microsoft Office
- Claims Support Communication
- Attention to detail
- Claims file documentation
- Claims investigations
- OneNote
- Customer service
- Claims processing
Timeline
E&I PRC Claims Adjuster
United Healthcare
01.2023 - Current
Provider Service Advocate
United Health care
05.2021 - 12.2022
Customer Care Representative
Apex Systems
10.2020 - 02.2021
Medical Records Specialists
Metro Inclusive Health
06.2017 - 04.2019
Service Advocate V
Florida Blue
07.2011 - 07.2016
High School Diploma -
King High
Some College (No Degree) -
SPC