Summary
Overview
Work History
Education
Skills
Timeline
Generic

Brianna Grayson

Gainesville,GA

Summary

Qualified Claims Representative versed in investigating claims, verifying information and managing settlements. Friendly and upbeat team player with organized and disciplined approach. Offering 5 years of insurance experience.

Overview

8
8
years of professional experience

Work History

Claims Representative

Middleby Residential
10.2021 - Current
  • Reviews coverage and effectively communicated the claims process to customer, ensuring clarity and understanding.
  • Conduct thorough investigations and research on claims, gathering supporting documents and written/recorded statements.
  • Handles property claims with minimal direction and oversight, efficiently bringing them to a resolution.
  • Produces grammatically correct and well-written correspondence, including letters, memos, reports and comprehensive claim file documentation.
  • Provides informed recommendations on claims, including cases with potential grounds for coverage denial.
  • Adapts to changing environments and utilizes new techniques to enhance performance and efficiency.
  • Analyzes and addresses escalated claims to resolve issues quickly.
  • Update claims system to track claim status and provide relevant information to other department.

Claims Representative

United Healthcare Group
05.2019 - 09.2021
  • Ensured accurate and timely submission of claims, adhering to company policies and procedures.
  • Reviewed and verified patient insurance information, including policy numbers and coverage details, to ensure proper billing and reimbursement.
  • Worked productively in fast-moving work environment to process large volumes of claims.
  • Conducted research and analysis to resolve claim denials or underpayment issues, working closely with patients, healthcare providers, and internal shared services teams.
  • Updated claims system to track claim status and provide relevant information to other department.
  • Collaborated with patients, providers, and internal stakeholders to ensure the receipt and completeness of all necessary documentation, in accordance with program policy and regulatory requirements.
  • Consistently achieved a high daily claims completion rate of 75%-80%, surpassing company benchmarks and demonstrating exceptional productivity and efficiency.
  • Maintained strong knowledge of basic medical terminology to better understand services and procedures.

Customer Service Representative

Global Industrial
01.2015 - 03.2019
  • Handled customer inquiries and suggestions courteously and professionally.
  • Actively listened to customers, handled concerns quickly and escalated major issues to supervisor.
  • Clarified customer issues and determined root cause of problems to resolve product or service complaints.
  • Processed customer service orders promptly to increase customer satisfaction.
  • Answered customer telephone calls promptly to avoid on-hold wait times.
  • Responded to customer requests, offering excellent support and tailored recommendations to address needs.
  • Educated customers about billing, payment processing and support policies and procedures.
  • Met customer call guidelines for service levels, handle time and productivity.

Education

High School Diploma -

Gainesville High School
Gainesville, GA
05.2009

Skills

  • Exceptional Recordkeeping Abilities
  • Professional Development
  • Settlement Verification
  • Customer Account Management
  • Written and Verbal Communication
  • Asset Recovery
  • Customer Retention Strategies
  • Strong Analytical Skills
  • Use of Multiple Systems
  • Performance Management
  • Typing 50 WPM
  • Remote Experience

Timeline

Claims Representative

Middleby Residential
10.2021 - Current

Claims Representative

United Healthcare Group
05.2019 - 09.2021

Customer Service Representative

Global Industrial
01.2015 - 03.2019

High School Diploma -

Gainesville High School

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Brianna Grayson