Summary
Overview
Work History
Education
Skills
Timeline
Hi, I’m

Brittany Moses

Columbia,SC
Brittany Moses

Summary

Customer Management Professional. Possess more than 10 years of successful experience as a Customer Management Professional. Experience extends to work with Medical Insurance Groups and Supplemental Insurance Groups as well as Global Fast Food Restaurants. A highly dynamic, team-spirited, results-oriented professional seeking to combine outstanding training with excellent work experience to make significant contribution in administrative environments. Effective Medical Claims Processor with strong background building rapport with providers to discuss claim status or claim denials. Driven performer equipped to handle multiple administrative tasks effectively. Exemplary worker with highly investigative skills when processing claims. Responsible Medical Claims Processor with strong attention to detail and juggles multiple tasks. Bilingual go-getter committed to handling claims expeditiously.

Overview

17
years of professional experience

Work History

PWC
Columbia

Medical Claims Specialist
08.2017 - 05.2023

Job overview

  • Effectively utilize Group cast and Epic professional billing systems to store patient demographics and ensure premiums are correctly posted.
  • Analyze medical claims in full detail to make sure payments are being issued correctly
  • Communicate with private and/or commercial insurance groups, and control accounts receivable operations to obtain additional information or confirm changes
  • Research customer correspondence, account invoices, and payment history
  • Research the disposition of funds not paid as billed or allocated with appropriate suspense account
  • Generate correspondence to medical providers for services rendered to patients
  • Research and provide effective reasons why claims are being denied
  • Excellent mathematic skills to solve problems
  • Analyze and handle correspondence from various sources
  • Create excels reports of all payments processed daily
  • Effectively utilize Microsoft Office Applications (Word, Excel, PowerPoint, Access) to categorize/file records, perform data management, draft/edit office memos.
  • Submitted electronic/paper claims documentation for timely filing.
  • Used administrative guidelines as resource or to answer questions when processing medical claims.
  • Responded to correspondence from insurance companies.
  • Managed large volume of medical claims on daily basis.
  • Reviewed provider coding information to report services and verify correctness.
  • Maintained knowledge of benefits claim processing, claims principles, medical terminology, and procedures and HIPAA regulations.

Aflac Group
Columbia

Customer Service Specialist II
07.2016 - 01.2017

Job overview

  • Receive general requests via inbound calls and e-mail research inquiries that policyholders have regarding coverage, claims and premium pertaining to supplemental insurance
  • Build and retain client relationships to ensure consistent business pipeline by maintaining ongoing contact via email and outbound calls
  • Effectively utilize Genelco, Workdesk, Work Flow, CAIC Production, CRM database systems to gather information to be researched
  • Accurately communicate with Management, Account Managers; as well as other departments to resolve escalated issues from policyholders
  • Consistently meets all Customer Service metrics which helps to assist in meeting service levels for the department
  • Communicate customer needs and complaints to management via Escalations Database
  • Highly knowledgeable on Aflac Group’s service and products
  • Generate duplicate certificates and claims forms to policyholders upon request
  • Update accounts as needed when policyholders have a change in mailing address
  • Communicate accurate information to policyholders regarding guideline and regulations outlined in their certificate for their specified Group
  • Submit port request in the Work Flow database for eligible policyholders for continuation of coverage
  • Provide adequate procedures for requesting loans for whole life policies
  • Effectively utilize Microsoft Office Applications (Word, Excel, PowerPoint, Access) to categorize/file records, perform data management, draft/edit office memos
  • Knowledge of the insurance industry, to include products, processes, and terminology and the ability to interpret complex language in state insurance laws and regulations.

McDonald’s
Sumter

Crew Member/Shift Lead
12.2015 - 07.2016

Job overview

  • Supervise inventory management, storage and preparation of food and supplies
  • Manage a team of five to 15 employees
  • Maintain a clean and safe work environment
  • Manage cash handling duties
  • Prepare cash drawers for employees to receive money for purchases
  • Transport money to banks for deposits and withdraws
  • Establish excellent management skills to use throughout my future.

Teleperformance
Columbia

Customer Service Representative
11.2014 - 06.2015

Job overview

  • Provide excellent customer service skills
  • Receive inbound calls; Assist customers with inquiries regarding billing inquiries for DirecTV
  • Provide explanations to customes on the origin and nature of the problem
  • Identify concerns of customers and actively communicate with the appropriate departments to de-escalate concerns
  • Effectively utilize Microsoft Office Applications (Word, Excel, PowerPoint, Access) to categorize/file records, perform data management, draft/edit office memos
  • Perform general clerical and administrative duties to include, but not limited to: photocopying, faxing and mailing.

Sykes Enterprises
Sumter

Customer Service Agent
03.2013 - 07.2013

Job overview

  • Provide excellent customer service skills
  • Receive inbound calls for Bank of America customers; Assist with inquiries regarding account information such as: funds transfers, automatic funds transfers (AFTs), stop payments, inquiries about bank deposit products and service charges, inquiries about ATM and debit card usage and limits, inquiries about checking and savings accounts transactions, inquiries about funds availability, and check verification requests by third parties
  • Verify information on ATM/debit card applications to the information in customer database.

Walmart
Sumter

Photo Lab Technician
03.2011 - 08.2012

Job overview

  • Maintains appropriate records of negatives and prints to ensure customer satisfaction
  • Inspect rolls of film to detect imperfections or defects, which may result in poor quality during the development of prints
  • Enlarges photographs, retouches negatives and edits prints.

Palmetto GBA
Columbia

Customer Support Specialist
08.2008 - 02.2009

Job overview

  • Receive inbound calls from customers regarding inquiries pertaining to health insurance plans and prescription drugs
  • Enroll Medicare recipients into prescription drug plans
  • Advise customers of what benefits are available to them
  • Help assist callers with enrolling in programs that will assist in lowering the cost of prescriptions and insurance plan costs.

Zesto’s Chicken
Columbia

Cashier
01.2008 - 07.2008

Job overview

  • Assist with cash transactions; issue receipts, change and tickets for orders
  • Maintain a clean and safe work environment
  • Establish excellent customer service skills.

Church’s Chicken
Columbia

Cashier
11.2006 - 02.2007

Job overview

  • Assist with cash transactions; issue receipts, change and tickets for orders
  • Maintain a clean and safe work environment
  • Establish excellent customer service skills.

Education

Dreher High School
Columbia, SC

High School Diploma
05.2008

University Overview

Trident University International
Cypress, CA

No Degree from Certificate in Medical Coding And Billing
11.2019

University Overview

Ultimate Medical Academy - Clearwater
Clearwater, FL

Associate of Science from Medical Insurance Coding
12.2023

University Overview

Skills

  • Customer Service
  • Documentation and Regulatory Compliance
  • Communication Skills (verbal and written)
  • Work with Diverse Group of Professionals
  • Training
  • Case Management
  • Problem Solving
  • Project Management
  • Conflict Resolution
  • Accounts Receivable
  • Inventory
  • Extensive Policy and Claim Research
  • Exceed Expectations
  • Strategy Skills
  • Reading Comprehension
  • Patient Admission
  • Microsoft Project
  • Medical Terminology
  • Telephone Etiquette
  • Data Security Procedures
  • Critical Thinking
  • ICD-10 Coding
  • Benefits Guidelines
  • Thorough Claims Reviews
  • Health Insurance Industry Knowledge
  • Claim Validity Determination
  • Customer Satisfaction
  • Insurance Policy Coverage Knowledge
  • Microsoft Dynamics
  • Corporate Policies and Procedures
  • Patient Confidentiality
  • Electronic Health Records
  • Provider Relations
  • Complex Problem-Solving
  • Tracking Spreadsheets
  • HIPAA Procedures
  • Outpatient Procedures
  • Insurance Plan Verification
  • Organizational Policies
  • Meticulous Recordkeeping
  • Insurance Claims Management
  • Microsoft Office
  • Active Learning
  • Electronic Claims Processing
  • Medical Terms and Procedure Knowledge
  • Insurance Claims
  • ICD Codes
  • Performance Review
  • Reviewing Patient Information
  • Accounts Payable and Accounts Receivable
  • Past Due Balance Management
  • Policy Modification
  • Document Scanning
  • Medical Billing and Coding
  • Medical Records and Documentation
  • Determine Medical Necessity
  • Health Management Information Systems
  • Scheduling Software

Timeline

Medical Claims Specialist
PWC
08.2017 - 05.2023
Customer Service Specialist II
Aflac Group
07.2016 - 01.2017
Crew Member/Shift Lead
McDonald’s
12.2015 - 07.2016
Customer Service Representative
Teleperformance
11.2014 - 06.2015
Customer Service Agent
Sykes Enterprises
03.2013 - 07.2013
Photo Lab Technician
Walmart
03.2011 - 08.2012
Customer Support Specialist
Palmetto GBA
08.2008 - 02.2009
Cashier
Zesto’s Chicken
01.2008 - 07.2008
Cashier
Church’s Chicken
11.2006 - 02.2007
Dreher High School
High School Diploma
Trident University International
No Degree from Certificate in Medical Coding And Billing
Ultimate Medical Academy - Clearwater
Associate of Science from Medical Insurance Coding
Brittany Moses