Summary
Overview
Work History
Education
Skills
Certification
Timeline
Generic

Briana Walker

Remote

Summary

Versatile professional with substantial experience with overall case management and claims processing with Dominion Dental Insurance. Expert in data analysis, relationship management, and proficient in resolving complex claims, and improving operational effectiveness. Capable of leveraging computer systems, including electronic systems and Microsoft Excel, to maximize compliance and accuracy, to the benefit of customers and positive workflow efficiencies.

Overview

7
7
years of professional experience
1
1
Certification

Work History

Case Management

Velera
09.2024 - Current
  • Reviewed and handled chargeback claims while ensuring compliance with procedures and regulations within the industry.
  • Utilized specific software to track and review the chargeback process to be more efficient in our operations.
  • Reviewed the information entered into the database system for accuracy and completeness.
  • Identified and investigated fraudulent transactions by reviewing credit card applications and transaction histories.
  • Reviewed the information entered into the database system for accuracy and completeness.

Claims Representative/ Benefits Specialist

Dominion Dental Insurance
Remote
01.2023 - Current
  • Utilize multiple software systems to maintain accurate customer account information and update records as necessary.
  • Interpret insurance policies to effectively communicate coverage details and benefits to clients.
  • Process and analyze customer claims, maintaining high levels of accuracy and attention to detail.
  • Resolve escalated claims, coordinating with medical providers when necessary, to achieve customer satisfaction and adhere to regulatory standards.

Health Benefits Specialist

Blue Cross Blue Shield Arizona
Remote
04.2021 - 01.2023
  • Addressed customer inquiries, clarifying coverage options and resolving issues related to plan details.
  • Processed requests for medical information release, ensuring accuracy and compliance with regulations.
  • Assisted with the resolution of claim adjudication queries and denials by investigating and rectifying coding errors.
  • Coordinated with various teams to facilitate the effective execution of health benefit plans, maintaining alignment with company standards and procedures.
  • Responded promptly to customer inquiries regarding their benefits and eligibility status.

Customer Service Representative

ADT
12.2018 - 03.2021
  • Enhanced customer relationship management by integrating advanced tools, optimizing workflows, and establishing automated triggers to meet client needs effectively.
  • Educated customers on product features and benefits, providing comprehensive support for troubleshooting and website/app navigation.
  • Conducted audits of internal data and processes, identifying areas for improvement to align with evolving business strategies and enhance overall performance.

Education

Bachelor of Science -

Colorado Technical University
Colorado Springs, CO

Skills

  • Electronic systems
  • Client relations skills
  • Call centers
  • Client inquiries
  • Policy knowledge
  • Microsoft Excel expertise
  • Medicaid
  • Medicare
  • Benefits administration
  • Microsoft Office proficiency
  • Data analysis

Certification

Google IT Professional Certificate

Timeline

Case Management

Velera
09.2024 - Current

Claims Representative/ Benefits Specialist

Dominion Dental Insurance
01.2023 - Current

Health Benefits Specialist

Blue Cross Blue Shield Arizona
04.2021 - 01.2023

Customer Service Representative

ADT
12.2018 - 03.2021

Bachelor of Science -

Colorado Technical University

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