BRIANNA L. LYONS
Clarksville,TN
Summary
Skilled in handling complex insurance claims and policy processing with experience in navigating through various insurance software systems. Demonstrates strong analytical skills, adept at interpreting policies and efficiently resolving claims to the satisfaction of all parties involved. Known for maintaining high accuracy levels in document processing and data entry, contributing to streamlined operations and improved customer service outcomes. Continuously seeks ways to optimize workflows and enhance team productivity, leading to more efficient claim resolution processes.
Overview
5
5
years of professional experience
Work History
Medical Claims Specialist
Cigna Health Group
Clarksville, TN
09.2023 - Current
- Stayed current on HIPAA regulations, benefits claim processing, medical terminology, and other procedures.
- Ensured compliance with applicable federal and state laws governing healthcare payments.
- Reviewed administrative guidelines whenever questions arose during the processing of claims.
- Assisted claimants, providers, and clients with problems or questions regarding claims.
- Inputted data into the system, maintaining the accuracy of provider coding information and reported services.
- Responded promptly to customer inquiries regarding claim status updates.
Quality Assurance Agent
AUTOMATED HEALTH SYSEMS - TennCare
Nashville, TN
03.2021 - 09.2023
- Responsible for real time analysis of all Contact Center traffic utilizing the Workforce Management Suite application
- Made effective decisions to manage volumes, approved time off, shift changes and Contact Center activities that affect staffing and the department’s ability to meet Service Level Agreements
- Analyzed calls from Customer Service Representatives and graded the calls
- Completed reports sent by the state of Tennessee
- Completed all required escalations when needed
Remote Customer Service Representative
CONDUENT
Clarksville, TN
07.2019 - 03.2021
- Answered inbound calls and assisted customer with product concerns
- Use problem solving skills to address any concerns the customers had
- Provided World Class Customer Service to every customer I encountered
- Assigned customers to the appropriate department if more assistance was needed outside of my scope of support
- Received inquiries directly from providers via telephone, email, or provider visits and worked to find root cause and resolutions
Education
Associate of Applied Science - Accounting
Motlow State Community College
Nashville, TN01.2019
High School Diploma -
Smyrna High School
Smyrna, TN01.2018
Skills
- Claims processing
- Medical billing
- Payment posting
- Healthcare compliance
- Critical Decision-making
- Insurance claims management
- Insurance claims processing
- Customer service
References
Available upon request
Timeline
Medical Claims Specialist
Cigna Health Group
09.2023 - Current
Quality Assurance Agent
AUTOMATED HEALTH SYSEMS - TennCare
03.2021 - 09.2023
Remote Customer Service Representative
CONDUENT
07.2019 - 03.2021
Associate of Applied Science - Accounting
Motlow State Community College
High School Diploma -
Smyrna High School
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