Arkecia Richardson
Pinson,Alabama
Summary
Experienced in patient admissions and claims processing, with a strong focus on effective communication and problem-solving. Proven analytical skills in fraud detection and compliance monitoring, ensuring efficient operations and equitable resolutions for all stakeholders.
Overview
33
33
years of professional experience
Work History
Claim Service Adjuster
ALLSTATE INSURANCE COMPANY
Birmingham, Alabama
01.2005 - 06.2024
- Handled complex inquiries regarding claim policies and procedures from providers and attorneys.
- Assessed value of claims and negotiated settlements or denials for equitable outcomes.
- Evaluated medical claims by gathering and analyzing relevant data to ensure accuracy.
- Identified potential fraud cases through thorough investigation of claims data for referrals.
- Documented claim files with comprehensive notes, maintaining compliance with state regulations.
- Scheduled files for independent medical examinations to expedite claims processing.
- Monitored employee file handling to ensure adherence to state statutes and guidelines.
Claims Processing Specialist
ALLSTATE INSURANCE COMPANY
Birmingham, Alabama
01.2004 - 01.2005
- Checked eligibility, benefits, claims status, and authorized services for members and providers to ensure compliance with policy requirements.
- Determined eligibility for pre-certification of services requested based upon policy and benefit protocols.
- Handled calls in a call center environment for pre-certification or referral to preferred providers and facility.
- Conducted scheduled follow-up investigations to assess claim closure probability and expedite resolution.
- Issued medical payments and provided updated information to facilitate timely processing and communication.
- Acquired knowledge of claims procedures, medical billing (ICD-9 & CPT CODES) and medical terminology.
Claims Examiner
COMPUTER SCIENCES CORPORATION
Birmingham, Alabama
01.1999 - 01.2001
- Reviewed medical claims for accuracy and timely payments.
- Handled incoming calls regarding eligibility, benefits, claims, and service authorizations for providers and members.
- Provided exceptional customer service in a high-volume call center, managing 50-75 calls daily.
- Acquired knowledge of claims procedures in healthcare, medical billing (ICD-9 & CPT CODES) and medical terminology.
Administrative Assistant
Trinity United Methodist Church
Birmingham, Alabama
01.1991 - 01.1999
- Organized and managed student accounts and financial statements for efficient daily operations.
- Maintained employee records and student files to ensure accurate information management.
- Prepared monthly newsletter for parents and staff to enhance communication and engagement.
Education
Senior Claims Law Associate-certification -
American Educational Institute
Birmingham, Alabama04-2008
B.S - Human Resources Management
Faulkner University
Birmingham, Alabama05-2005
Childhood Development Associate -
Jefferson State Community College
Birmingham, Alabama10-1998
Skills
- Patient registration
- Fraud investigation
- Scheduling procedures
- Time management
- Critical thinking
- Insurance verification
- Effective communication
- Problem solving
- Conflict resolution
Timeline
Claim Service Adjuster
ALLSTATE INSURANCE COMPANY
01.2005 - 06.2024
Claims Processing Specialist
ALLSTATE INSURANCE COMPANY
01.2004 - 01.2005
Claims Examiner
COMPUTER SCIENCES CORPORATION
01.1999 - 01.2001
Administrative Assistant
Trinity United Methodist Church
01.1991 - 01.1999
Senior Claims Law Associate-certification -
American Educational Institute
B.S - Human Resources Management
Faulkner University
Childhood Development Associate -
Jefferson State Community College