Bowens Samesha
Columbus,United States
Summary
Smart candidate keeps meticulous details on the status of customer service, collections, and claims efforts. Friendly and engaging with great attention to detail. Successful account representative provided ongoing support to ensure client satisfaction. Identified market trends, understood the competitive landscape, and possessed excellent communication skills to explain customer options. Analytical problem-solver with excellent communication skills. Effective at interviewing claimants, compiling records, and documenting findings. Well-versed in insurance policies, practices, and standards. Qualified Claims Representative versed in investigating claims, verifying information, and managing settlements. Friendly and upbeat team player with an organized and disciplined approach. Offering 6 years of insurance experience. Experienced [Type] Insurance Specialist successful at managing high caseloads in fast-paced environments. Organized, driven, and adaptable with excellent planning and problem-solving abilities. Offering 7 years of experience and willingness to take on any challenge.
Overview
25
25
years of professional experience
Work History
Account Representative Specialist
Randstad, Aflac
04.2022 - 09.2022
- Performs routine clerical accounting functions by establishing policies, procedures, and guidelines.
- Reconciles and balances invoices from small to large payroll accounts; reviews account payments to determine.
- Disposition of funds; identifies discrepancies or account variances and takes the necessary steps to resolve or refers to
- The team Lead or Supervisor
- Use multiple systems such as
- Genelco, CRM, and Workflow to input appropriate data.
Office Manager
Greene/Glenn Finance Co
03.2010 - 02.2022
- Greene/Glenn Finance Co - -
- Responsible for collecting delinquent accounts and collecting payments or working out a repayment schedule.
- Verify supplied documents, determines qualifications, approve or deny the loan and ultimately communicate the decision to the applicant
- Ensure all policies have been followed in the approval of the loan, all signatures are on all documents, and the loan documentation includes the correct data at the time of closing the loan
- Performs duties under general supervision by established guidelines
- Answers telephones, ascertains nature of the call, and directs caller to appropriately desired locations Serve as the initial point of contact for the program Prepare fund request documents for wiring funds to close
- Prepare commitment letter(s), denial letter(s), and cancel files when necessary Act as a liaison between the borrower, underwriter, loan originator, and lender.
Customer Service/Claims Representative
Blue Cross Blue Shield / Anthem
02.2014 - 03.2016
- Interface daily with internal associates to obtain a probable outcome for our providers and members.
- Code and process claims forms for payment ensuring all information is supplied before eligible payments are made.
- Research and analyze claims issues.
- Review, analyze, and process claims/policies related to events to determine the extent of the company's liability and entitlement.
- Research and analyze claim issues.
- Respond to inquiries, may involve customer/client contact.
- Sought clarification from physicians and other hospital personnel for answers to any needed coding interpretations before abstracting records
- Performed insurance verification, pre-certification and pre-authorization
- Investigated past due invoices and delinquent accounts to generate revenues and reduce the number of unpaid and outstanding accounts
- Managed benefit contract pricing, processing, policies, and procedures.
- Advised customers on required information for claim submissions to progress applications.
- Worked productively in a fast-moving work environment to process large volumes of claims.
- Developed an in-depth understanding of insurance policies and procedures to give accurate recommendations to suit clients' needs.
- Updated claims system to track claim status and provide relevant information to another department.
- Researched and analyzed complex claims to determine the next steps and possible outcomes.
Account Manager
GoldCar Lending Inc. Gil's Auto Sales
10.2012 - 02.2014
- Analyzed applicants' financial status, credit and property evaluation to determine feasibility of granting loan
- Determined appropriate rate locks, issuance of disclosures, overage and underage waivers and fee waivers
- Provided expert financial advice on mortgage and both educational and personal loans
- Listened carefully to customer complaints and ensured swift and effective resolution by taking appropriate action
- Identified valuable solutions for customers with credit problems
- Reviewed credit histories from applicants and determined feasibility of granting requested loans
- Educated customers on variety of loan products and available credit options to promote valuable decision- making
- Spent ample time with each applicant to break down complex information into terms that easy to understand
- Reported daily averages and shortages to operations department.
Clerk II
New Horizons CSB
05.2005 - 11.2012
- Created highly effective organizational and filing system, resulting in easy access to critical information and streamline office functioning
- Act as liaison and maintained open lines of communication among CEO, Mental
- Health agencies, and contracted Provides administrative support including typing/word processing, mail preparation, copying, distribution, telephone calls, and travel orders
- Educated patients on various resources, services and programs to maximize care
- Collaborated with social workers to support patients
- Partnered with interdisciplinary teams to implement care plans.
- Built and maintained strong relationships with patients by successfully resolving issues and responding promptly to phone inquiries
- Maintained confidential patient documentation to prevent data compromise and comply with HIPAA regulations
- Recommended improved life choices to enhance client outcomes
- Observed safety protocols to minimize accidents and spread of disease
- Discussed available program services with potential participants and outlined procedures to facilitate smooth engagement in program processes
- Evaluated patient behavior and reported changes to clinical team.s.
Pharmacy Technician
CVS Pharmacy
07.1999 - 05.2005
- Answered incoming phone calls and addressed questions from customers and healthcare providers.
- Calculated dosage, filled prescriptions, and prepared prescription labels with absolute accuracy.
- Solved customer problems in-person or over the telephone by assisting with placing orders, navigating systems, and locating items.
- Stocked, labeled, and inventoried medication to keep accurate records.
- Counted and labeled prescriptions with correct item and quantity.
- Entered and processed patients' prescriptions into the internal system.
- Performed a wide range of pharmacy operations with a strong commitment to accuracy, efficiency, and service quality.
- Assisted pharmacist by filling prescriptions for customers and responding to patient questions regarding prescription and medication-specific issues.
- Performed various pharmacy operational activities with a strong commitment to accuracy, efficiency, and service quality.
Personnel Assistant
CVS Pharmacy
03.1998 - 07.1999
- Improved drug inventory management procedures to reduce waste and eliminate backorders or overstock.
- Answered patient questions regarding medication.
- Prepared medication labels with item name and quantity.
- Processed prescription transfer requests from competitors
- Dispensed medications to patients in accordance with pharmacist orders
- Performed wide range of pharmacy operations with strong commitment to accuracy, efficiency and service quality
- Promoted health and well- being of patients by administering flu immunizations
- Retrieved voicemails to better assist customers.
- Managed medication stocks, including conducting counts, labeling products and maintaining controls.
- Prepared prescription transfer requests from competitor companies
- Created new customer profiles and updated information in pharmacy computer systems
- Reconciled payroll accounts.
- Assisted in termination procedures.
- Assisted with recruiting, background checks and reference checks.
- Processed business and identification cards, bank accounts, reference and medical checks to streamline hiring protocol
- Spearheaded full-cycle HR processes including, advertising jobs, booking interviews, conducting hiring activities and interviews, investigating candidate backgrounds and orienting new employees
- Set up appointments, meetings and conferences for employees
- Executed HR department clerical duties such as filing, sorting and delivering mail and bookkeeping.
- Led recruitment functions, including developing job postings, scheduling interviews and overseeing employee onboarding.
- Reviewed all candidate documentation, including identification, references and background checks in alignment with hiring protocol.
- Directed personnel, training and labor relations activities.
Education
Associate Degree - Business Administration, Health Insurance
Columbus Technical College
Columbus, GA02.2007
Skills
- Payroll (4 years)
- Client Liaison
- Filing (8 years)
- Account and Ledger Reconciliations
- Email Correspondence
- Office Management Software
- Financial Tracking
- Monthly Closings
- Prior Authorization Processing
- Recordkeeping Organization
- Premium Calculations
- Promotions Programs
Timeline
Account Representative Specialist
Randstad, Aflac
04.2022 - 09.2022
Customer Service/Claims Representative
Blue Cross Blue Shield / Anthem
02.2014 - 03.2016
Account Manager
GoldCar Lending Inc. Gil's Auto Sales
10.2012 - 02.2014
Office Manager
Greene/Glenn Finance Co
03.2010 - 02.2022
Clerk II
New Horizons CSB
05.2005 - 11.2012
Pharmacy Technician
CVS Pharmacy
07.1999 - 05.2005
Personnel Assistant
CVS Pharmacy
03.1998 - 07.1999
Associate Degree - Business Administration, Health Insurance
Columbus Technical College
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