Ashley Carter
Detroit,MI
Summary
Reliable and highly skilled credentialing specialist with 7+ years of Administrative experience also deep knowledge of Healthcare, Insurance Claims Management and Airline Industry . Extraordinary professional communication skills with staff patients, able to function as part of a medical clerical team. Maintained credentialing database while tracking all direct provider contract data and performed primary and secondary source verifications of credentials according to departmental policy.
Overview
14
14
years of professional experience
Work History
Claims Specialist
Sedgwick
Southfield, MI
02.2017 - 08.2025
- Resolved claims by approving or denying documentation, calculated benefits due, and determined compensation settlement.
- Examined insurance claims to uncover evidence of fraud.
- Investigated insurance claims through interviews and assessments.
- Prepared reports, correspondence, and documents in a clear, concise, detailed, and comprehensive manner.
- Researched the terms and stipulations of insurance policies and authorized and processed claims once the amount of the claim payout has been determined.
- Ensured legal compliance by following company policies, procedures, and guidelines, as well as state and federal insurance regulations.
Flight Agent
WestJet Airlines
Chicago, IL
01.2015 - 01.2017
- Arranged flights, insurance, and accommodations using booking software.
- Collected and processed payments.
- Advised clients on travel arrangements, e.g. visas and passports.
- Kept clients up to date with any changes.
- Conducted pre-flight checks, briefed passengers on safety, ensuring compliance, securing the cabin, and managing emergencies like fires or medical incidents.
- Administered first aid, directing evacuations, and providing calm reassurance during turbulence or unexpected situations.
Credential Specialist
Aetna Medicaid
Detroit, MI
12.2011 - 06.2014
- Researched and resolved claim edits, pended claims, and denials through system investigation and internal/external contact.
- Verified procedure (CPT) and diagnosis (ICD) codes, updated member, provider, and policy information in systems.
- Utilized claims processing systems (like FACETS) to manage data, document decisions, and maintain organized claim records.
- Adamantly used software systems like Guidewire, Duck Creek, and ClaimVision for efficient claim handling.
Education
Associate of Arts - Business Communication
Northern Illinois University
Dekalb, IL05.2015
Skills
- Billing (3 years)
- Clerical
- Word (10 years)
- Microsoft Excel (10 years)
- Outlook
- Coding
- Medical Office
- Medical Billing
- Insurance Verification
- Communication
- Initiative and problem solving abilities
- Accounting
- Analysis skills
- Data entry
- Office experience
- Multi-line phone systems
- Administrative experience
Timeline
Claims Specialist
Sedgwick
02.2017 - 08.2025
Flight Agent
WestJet Airlines
01.2015 - 01.2017
Credential Specialist
Aetna Medicaid
12.2011 - 06.2014
Associate of Arts - Business Communication
Northern Illinois University