Hi, I’m
Brian McWright
Plant City,FL
Summary
Friendly insurance professional experienced in investigating and processing insurance claims. Hardworking and communicative individual excels at interpreting policies and negotiating payment solutions. Recognized for providing optimum service to policyholders and quickly managing assigned task load.
Overview
9
years of professional experience
3
years of post-secondary education
Work History
AllStateRemote, FL
Claims Specialist II
05.2022 - 09.2023
Job overview
- Reviewed insurance and claims documents to verify required information and secure any missing data for settlements.
- Collaborated with legal counsel to make organizational claims decisions aligning with governing laws.
- Responded to inquiries by answering questions, providing information and directing customers to appropriate resources.
- Followed up with customers on unresolved issues.
- Reviewed new files to determine current status of auto claim and to develop plan of action.
- Maintained confidentiality of patient finances, records, and health statuses.
- Maintained strong knowledge of basic auto terminology to better understand services and procedures.
- Posted payments to accounts and maintained records.
TRANZACTTampa, FL
Medicare Sales Agent
06.2021 - 03.2022
Job overview
- Advised and counseled customers through precise communication which insurance plans, benefits, claims & eligibility best suited their needs and budget
- Coordinate claims with Medicare and other group insurance carriers
- Determine proper payees for benefits in order to discharge company's liabilities
- Prepare documents relating to claims
- Take responsibility of payment of all claims in compliance with rules
- Respond to inquiries and resolve pertaining to specific claim issues
- Educated and advised policy holders and potential clients on claims/benefits to resolve gaps in medical coverage
- Provider Data Management
- Collected premiums on or before effective date of coverage
- Finalized sales and collected necessary deposits
- Conducted annual reviews of existing policies to update information
- Analyzed customer needs to provide customized insurance solutions
- Managed over 45 calls per day
Totalmed/CenteneBrandon, FL
Claims Processor
09.2020 - 12.2020
Job overview
- Compile information on practitioners practice and vendor information to create new contracts or add to pre-existing contracts
- Terminate providers upon client request
- Update provider practice information
- Managed assigned caseload with standard production requirements
- Used strong analytical and problem-solving skills to develop effective solutions for challenging situations.
- Cultivated interpersonal skills by building positive relationships with others.
- Collaborated with claims department and industry anti-fraud organizations to resolve claims.
- Managed workload and priorities to meet claims processing meet deadlines.
- Utilized excellent analytical and problem-solving skills to quickly and accurately assess insurance claims.
Health Plan OneTampa, FL
Healthcare Sales Agent
09.2019 - 12.2019
Job overview
- Advised and counseled customers through precise communication which insurance plans, benefits, claims & eligibility best suited their needs and budget
- Coordinate claims with Medicare and other group insurance carriers
- Determine proper payees for benefits in order to discharge company's liabilities
- Prepare documents relating to claims
- Take responsibility of payment of all claims in compliance with rules
- Respond to inquiries and resolve pertaining to specific claim issues
- Educated and advised policy holders and potential clients on claims/benefits to resolve gaps in medical coverage.
- Assisted call-in customers with questions and orders
- Provided superior service to customers by quickly and courteously responding to requests, inquiries, suggestions and concerns
AllSource PPSTampa, FL
Case Manager/Claims Processor
09.2018 - 02.2019
Job overview
- Manages assigned caseload with limited supervision
- Follows established policies and practices to resolve claim issues
- Responsible for quality check of claims processed in claim system for processing and financial accuracy
- Reviews claim data to make claim settlement decisions
- Appropriately escalates issues to supervisor for resolution as needed
- Performs other related duties as assigned or required
- Approved and denied employee's claims based on federal requirements
- Processed claims based on information received
- Handle customer calls and inform employees of FMLA process
- Make decisions using critical thinking on sensitive claims
One Touch DirectTampa, FL
Customer Service Representative
08.2016 - 08.2017
Job overview
- Handle customer's accounts and sensitive information
- Assist customer's inquiries regarding their phone, television, and broadband services, processed payments added value to customer accounts, actively sought one call resolution to provide efficient customer service
- Provided primary customer support to internal and external customers
- Answered constant flow of customer calls with minimal wait times
- Updated account information to maintain customer records
- Maintained customer satisfaction with forward-thinking strategies focused on addressing customer needs and resolving concerns
- Answered customer telephone calls promptly to avoid on-hold wait times
SubwayOlivet, MI
Sandwich Artist
06.2015 - 04.2016
Job overview
- Executed sandwich artistry duties with very low occurrence of errors
- Organized freezers, refrigerators and storage rooms by receiving, recording, and moving food and beverage supplies and products
- Prepared and presented food in compliance with health and safety guidelines
- Kept workplace clean and organized in line with restaurant policies
- Prepared and served hot and cold sandwiches based on customer preferences
- Identified price of goods and calculated bills with optical price scanners, calculators, and cash registers
- Kept pastry and dessert case stocked with fresh selections and arranged to entice orders
CheddarsBrandon, FL
Busser
01.2015 - 04.2015
Job overview
- Worked quickly, communicated with other staff and always looked for better ways of completing tasks to improve productivity and keep tables ready for incoming guests
- Collected trash, wiped up spills, and removed trays to maintain fresh and clean customer areas
- Kept close eye on customers to quickly spot leaving guests and clear tables for future patrons
- Organized and cleaned assigned sections by sanitizing and cleaning table, counter, and kitchen surfaces
- Trained new staff in bussing and cleaning procedures
- Developed excellent relationships with managers and fellow team members to support team success and positive work environment
- Transported dirty utensils, dishes, and trays to kitchen to help team stay on top of cleaning
- Helped manage operations of restaurants by cleaning up spills and other messes quickly to minimize hazards
Education
Olivet College
1 Year from Psychology
09.2015 - 04.2015
East Bay High SchoolGibsonton, FL
High School Diploma
08.2011 - 05.2014
University Overview
- Member of AVID
Skills
Deadline oriented,
Organized
Planner
Interpersonal skills
TelemarketingData EntryCase ManagementData AnalysisHealthcareClaims ProcessingCritical thinkingAnalysis SkillsDatabasesInsurance salesLeadershipHIPAAAssessmentsSales SkillsDevelopment
Video Editing
Additional Information
- Willing to relocate to:, Authorized to work in the US for any employer
Timeline
Claims Specialist II
AllState
05.2022 - 09.2023
Medicare Sales Agent
TRANZACT
06.2021 - 03.2022
Claims Processor
Totalmed/Centene
09.2020 - 12.2020
Healthcare Sales Agent
Health Plan One
09.2019 - 12.2019
Case Manager/Claims Processor
AllSource PPS
09.2018 - 02.2019
Customer Service Representative
One Touch Direct
08.2016 - 08.2017
Olivet College
1 Year from Psychology
09.2015 - 04.2015
Sandwich Artist
Subway
06.2015 - 04.2016
Busser
Cheddars
01.2015 - 04.2015
East Bay High School
High School Diploma
08.2011 - 05.2014