Summary
Work History
Education
Skills
Timeline
CustomerServiceRepresentative

CANDACE N. GRAY

LAS VEGAS,NV

Summary

Experienced team member with 15 years in the medical claims adjusting and adjudication industry. Committed and dependable, dedicated to delivering outstanding customer experiences while meeting productivity goals. Seeking a reputable organization that appreciates my extensive experience, meticulous knowledge, and collaborative nature to create lasting, memorable experiences for their clients. Organized and reliable candidate skilled at handling multiple priorities with a positive attitude. Willing to assume additional responsibilities to support team objectives.

Work History

Customer Service Representative

BakeMark Distributing - (Ultimate Staffing Agency)
05.2024 - 08.2024
  • Participated in cross-functional teams to discuss ways to improve overall customer satisfaction across company.
  • Maintained detailed records of customer interactions and transactions, ensuring accurate documentation and follow-up.
  • Investigated and resolved customer inquiries and complaints quickly.
  • Maintained up-to-date knowledge of product and service changes.
  • Collaborated with staff members to enhance customer service experience and exceed team goals through effective client satisfaction rates.
  • Identified and resolved discrepancies and errors in customer accounts.
  • Delivered prompt service to prioritize customer needs.

Senior Medical Claims Examiner

UNITED HEALTH GROUP, INC
02.2008 - 08.2023
  • Accurately processed large volume of medical claims every shift
  • Evaluated pending claims to identify and resolve problems blocking auto-adjudication
  • Reviewed claims for accuracy before submitting for billing
  • Consistent data input while maintaining accuracy of provider coding information and reported services
  • Stayed current on HIPAA regulations, benefits claim processing, medical terminology and/or other procedures
  • Referenced contract notes and processing manual to correctly apply group-specific classifications to claims

Claims Adjuster

AAA AUTO CLUB OF SOUTHERN CALIFORNIA
04.2007 - 02.2008
  • Reviewed, evaluated, and adjusted claims to promote fair and prompt settlement
  • Identified and obtained evidence to ascertain claim value
  • Gathered information from various third parties to determine claim acceptability
  • Negotiated and settled claims according to information presented through reports, research and/or data verification
  • Investigated questionable claims to determine payment authorization

Medical Claims Associate

HCA PATIENT ACCOUNT SERVICES
02.2005 - 04.2007
  • Based payment or denials of medical claims upon well-established criteria for claims processing
  • Tracked differences between plans to correctly determine eligibility and assess claims against benefits and data entry requirements
  • Referenced contract notes and processing manual to correctly apply group-specific classifications to claims
  • Reviewed administrative guidelines whenever questions arose during processing of claims
  • Reviewed claims for accuracy before submitting for billing
  • Consistent data input while maintaining accuracy of provider coding information and reported services
  • Stayed current on HIPAA regulations, benefit claims processing, medical terminology, and other procedures

Education

High School Diploma -

Woodrow Wilson High School
Long Beach, CA

Long Beach City College
Long Beach, CA

Skills

  • Insurance Claims
  • Claims Processing
  • Claims Evaluation
  • Computer Skills
  • Claim Form Analysis
  • Records Review
  • Claims Investigation
  • Lapsed Case Follow-Up
  • Verbal & Written Communication
  • Empathetic Telephone Etiquette
  • World Class Customer Service
  • Microsoft Outlook

Timeline

Customer Service Representative

BakeMark Distributing - (Ultimate Staffing Agency)
05.2024 - 08.2024

Senior Medical Claims Examiner

UNITED HEALTH GROUP, INC
02.2008 - 08.2023

Claims Adjuster

AAA AUTO CLUB OF SOUTHERN CALIFORNIA
04.2007 - 02.2008

Medical Claims Associate

HCA PATIENT ACCOUNT SERVICES
02.2005 - 04.2007

Long Beach City College

High School Diploma -

Woodrow Wilson High School

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CANDACE N. GRAY