Summary
Overview
Work History
Education
Skills
Software System Expertise
Timeline
Generic

Barbara Willimas

Humble,Tx

Summary

  • Seasoned Claims Processor evaluating online entry, error correction and quality control review for final adjudication of claims. Strong business and financial acumen with proven success to maintain efficient operations. Extensive knowledge of billing, collections and fiduciary management.
  • Friendly Insurance Verification Specialist promoting a background in keeping sensitive patient data confidential while maintaining knowledge of Medicaid and private policy benefits. Possessing great relationship building and communication skills. Looking to tackle new challenges with a company that values dynamic skills and a strong work ethic.
  • Highly-motivated employee with desire to take on new challenges. Strong worth ethic, adaptability and exceptional interpersonal skills. Adept at working effectively unsupervised and quickly mastering new skills.
  • Hardworking employee with customer service, multitasking and time management abilities. Devoted to giving every customer a positive and memorable experience.
  • Committed job seeker with a history of meeting company needs with consistent and organized practices. Skilled in working under pressure and adapting to new situations and challenges to best enhance the organizational brand.
  • Organized and motivated employee eager to apply time management and organizational skills in various environments. Seeking entry-level opportunities to expand skills while facilitating company growth.
  • Recent graduate with excellent research, technical and problem-solving skills. Detail-oriented and able to learn new concepts quickly.
  • Motivated high school student with a track record of academic excellence looking for part-time work. Intends to develop professional work experience utilizing excellent communication and time management skills.

Overview

12
12
years of professional experience

Work History

Senior Claims Intake Specialist

The CCS Companies
Houston, TX
07.2019 - Current
  • Performed intake assessments for insurance claims to guarantee the precision and entirety of data.

Process incoming claims within established timelines, achieving a 95% on-time intake rate
Verify claim eligibility and coverage details, reducing claim errors by 20%.

● Collaborate with claims adjusters and providers to gather additional claim information as needed.
Processed incoming claims within established timelines, achieving a 95% on-time intake rate.

  • Reviewed incoming claims to guarantee accuracy of information, completeness of documentation, and adherence to policy guidelines.
  • Provided accurate information and addressed customer inquiries promptly to resolve discrepancies.
  • Compiled customer documents for Claims Adjuster team review.
  • Facilitated cross-departmental collaboration as a liaison between customer service and different organizational units.
  • Identified and reported potential fraud cases to management for further investigation.
  • Processed new claims following established procedures such as entering data into the system, verifying coverage eligibility, and ensuring compliance with regulations.
  • Verified accuracy of interest calculations, premiums payable and loan surrender values.
  • Utilized insurance rate standards for calculating premiums, refunds, commissions and adjustments.
  • Conducted comprehensive analysis of automobile policies including third-party liability, accident benefits, and collision benefits.
  • Created concise summaries of payments, policy coverages, and damages for statements of loss.

Claims Intake Analyst

Texas Medical Associates
01.2017 - 06.2019
  • Reviewed and analyzed incoming claims, maintaining a 98% accuracy rate.
  • Conducted thorough reviews and analysis of applications to ascertain eligibility and establish a clear path for progression.
  • Ensured comprehensive maintenance of detailed records regarding inquiries and client information
  • Developed intake forms, questionnaires, and other documents for efficient data collection.
  • Utilized interview assessments to determine required interventions for clients.
  • Assisted clients in navigating through available resources within the organization.
  • Collaborated with various departments to ensure prompt and effective service provision.
  • Ensured seamless tracking of client progress and promptly addressed any concerns.
  • Evaluated client feedback to enhance existing programs or develop new ones.
  • Monitored and recorded information on intakes including client demographics, utilization of services, and attained results.
  • Generated reports to provide a comprehensive overview of program activities.
  • Monitored and documented vital information on intakes including client demographics, service usage, and attained results.
  • Scheduled and confirmed patient appointments for diagnostic, surgical, and consultation services.

Claims Intake Coordinator

ANGEL MEDICAL SUPPLY
08.2014 - 01.2017
  • Managed the intake of insurance claims, ensuring timely and accurate data entry into the system.
  • Coordinated intake process for new clients, scheduling initial assessments and providing necessary paperwork.
  • Maintained accurate records of client intakes in an efficient electronic database system.
  • Conducted comprehensive interviews with potential clients to determine eligibility for services.
  • Provided assistance to individuals, families, and groups in need of information and resources.
  • Developed personalized service plans for clients, aligning with their specific objectives and requirements.
  • Supported the process of determining suitable referrals to outside community agencies or programs for client support.
  • Met regularly with clients to review progress towards established goals and objectives.
  • Assisted clients in overcoming obstacles by implementing effective strategies.
  • Worked alongside diverse team members to guarantee the delivery of high-quality care.
  • Led group discussions aimed at tackling specific challenges related to clients' mental well-being.
  • Engaged in regular case conferences with clinical staff to discuss treatment planning and establish goals.
  • Monitored client's activities while at the facility and documented any changes in behavior or attitude.
  • Ensured compliance with relevant regulations pertaining to the provision of services.
  • Provided education about available services, benefits, rights, responsibilities, risks and benefits of treatment options.
  • Offered crisis intervention techniques when needed.
  • Adhered to confidentiality guidelines when handling sensitive information about clients.
  • Actively sought out opportunities for professional development through continuing education courses or workshops.
  • Answered phone calls to provide assistance, information and medical personnel access.

Claims Intake Specialist

Healthiest Infusion & Specialty
01.2012 - 08.2014
  • Processed incoming claims, ensuring all required information and documentation were complete and accurate.
  • Ensured the precision, integrity, and adherence to policy guidelines of incoming claims through thorough review and analysis.
  • Provided accurate information and responded promptly to customers' inquiries, resolving discrepancies effectively.
  • Compiled customer documents for Claims Adjuster team review.
  • Provided support in resolving intricate claim matters as necessary.
  • Identified and reported potential fraud cases to management for further investigation.
  • Served as a bridge between customer service and other organizational departments.
  • Processed new claims by following established procedures, which included entering data into the system, verifying coverage eligibility, and ensuring compliance with applicable regulations.
  • Delivered technical assistance and problem-solving expertise for claims intake processes.
  • Regularly updated status reports for all incoming claims using established tracking systems.
  • Stayed informed about industry trends, regulatory changes, and best practices to offer informed advice.
  • Developed streamlined processes to enhance efficiency in claims intake requests
  • Conducted quality assurance checks on all completed claims intake forms prior to submission.
  • Assisted in training newly hired employees on processing incoming claims.

Education

Nursing -

Prairie View A&M University College

Skills

  • Claims Intake
  • Insurance Industry Knowledge
  • Data Entry Accuracy
  • Customer Service
  • Quality Assurance
  • Problem-Solving
  • Attention to Detail
  • Communication Skills
  • Time Management
  • Team Collaboration
  • Microsoft Excel
  • Claims Management Software
  • Medical Terminology
  • Regulatory Compliance
  • Analytical Skills
  • Conflict Resolution
  • Claims Investigation
  • Document Management
  • Process Improvement
  • Software/System Proficiency
  • Insurance knowledge
  • Policy Interpretation
  • Payments posting
  • Microsoft Office
  • Claims review
  • Small Claims Payouts
  • Data Entry
  • Client Interviews
  • Appointment Scheduling
  • Insurance Coverage Verification
  • Excellent Communication

Software System Expertise

  • Claims Management Software (e.g., Epic, )
  • Microsoft Office Suite (Word, Excel, Outlook)
  • Customer Relationship Management (CRM) Systems
  • Electronic Health Record (EHR) Systems
  • Document Management Software
  • Data Entry Tools
  • Payment Processing Platforms
  • Compliance and Regulatory Software
  • Claims Investigation Tools
  • Reporting and Analytics Software
  • Collaboration Platforms
  • Task Management Systems
  • Telephony Systems
  • Training Management Software
  • Workflow Automation Tools

Timeline

Senior Claims Intake Specialist

The CCS Companies
07.2019 - Current

Claims Intake Analyst

Texas Medical Associates
01.2017 - 06.2019

Claims Intake Coordinator

ANGEL MEDICAL SUPPLY
08.2014 - 01.2017

Claims Intake Specialist

Healthiest Infusion & Specialty
01.2012 - 08.2014

Nursing -

Prairie View A&M University College
Barbara Willimas