Brittany Turner

• Examine insurance, medical, or disability claims for accuracy, completeness, and compliance with policy provisions.

• Evaluate supporting documentation and determine claim approval, denial, or adjustment based on guidelines and regulations.

• Ensure claims meet federal/state requirements, HIPAA standards, and company policies.

•Identify potential fraudulent or misrepresented claims and escalate for further investigation.

•Collaborate with policyholders, healthcare providers, attorneys, and internal teams to clarify discrepancies and resolve issues.

• Skilled in claims management systems (e.g., Facets, Epic, Xactimate, CMS platforms) and Microsoft Office

• Manage high-volume workloads independently while meeting accuracy, quality, and turnaround time.

• Deliver clear, empathetic explanations of claim determinations and benefit coverage.

• Research complex cases, interpret policy language, and recommend fair resolutions.

• Maintain accurate claim records, audit trails, and reporting to support compliance and transparency.

• Handled inbound calls, emails, and chat inquiries regarding insurance policies and claims.
• Explained benefits, eligibility, and claim statuses to policyholders with clarity and empathy.
• Escalated complex claim disputes to senior adjusters and tracked resolutions.
• Consistently exceeded performance metrics, including first-call resolution and response time.

• Review and process an average of 95 claims daily with 98%+ accuracy.
• Verify policyholder information, coverage eligibility, and required documentation.
• Communicate with providers, policyholders, and internal departments to resolve discrepancies.
• Utilize [claims software: e.g., Facets, Epic, Xactimate, etc.] to input and track claims.
• Meet and exceed daily/weekly productivity and quality standards in a fully remote environment.