Summary
Overview
Work History
Education
Skills
Certification
Timeline
Generic

Caroline Neal

Atlanta,GA

Summary

Highly trained professional with a background in verifying insurance benefits and creating appropriate patient documentation. An established Insurance Verification Specialist known for handling various office tasks with undeniable ease. 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.

Overview

8
8
years of professional experience
1
1
Certification

Work History

Health Benefits Advisor

United Healthcare
05.2021 - Current
  • Assisted employees in understanding their benefits options, providing clear explanations and guidance on available plans.
  • Observed strict procedures to maintain data and plan participant confidentiality.
  • Supported company-wide initiatives by serving as a benefits resource for managers looking to make informed decisions about employee compensation.
  • Streamlined benefits administration processes by implementing digital record-keeping and automated systems.
  • Consistently met deadlines for reporting requirements by efficiently managing workload without sacrificing quality.
  • Generated, posted and attached information to claim files.
  • Developed and implemented quality assurance processes to check accuracy of claims processing.
  • Identified fraudulent claims through thorough investigation and documentation of findings.
  • Reduced claim processing time for faster customer service and improved satisfaction rates.
  • Trained new employees on claims processing procedures, contributing to a well-prepared workforce.
  • Stayed current on industry trends and changes in insurance policies, enabling accurate interpretation of coverage details for various plans.
  • Contributed to positive team morale through active participation in department meetings, offering constructive feedback, and supporting colleagues when needed.
  • Checked documentation for accuracy and validity on updated systems.
  • Assisted in the development of training materials for new hires, improving overall team knowledge and productivity.

Patient Care Coordinator

AllianceRx Walgreens Prime
10.2020 - 05.2021
  • Assisted in the development of care plans tailored to individual patient needs, improving overall health outcomes.
  • Provided exceptional customer service by addressing concerns, answering questions, and ensuring patient satisfaction with their care experience at the clinic.
  • Coordinated transportation to get patients to and from medical appointments.
  • Taught patients and families to use at-home medical equipment.
  • Investigated and resolved customer inquiries and complaints quickly.
  • Assisted pharmacist by filling prescriptions for customers and responding to patient questions regarding prescription and medication-specific issues.
  • Investigated and resolved accounting, service and delivery concerns.
  • Demonstrated adaptability through cross-training in various roles within the pharmacy setting to better serve customers as needed.
  • Provided proactive solutions for common customer inquiries, leading to increased satisfaction ratings.
  • Managed confidential patient records with meticulous attention to detail while upholding privacy standards.
  • Explained medication use and side effects under pharmacist direction.
  • Monitored inventory levels to inform pharmacists of shortages and facilitate resupply.
  • Promoted superior experience by addressing customer concerns, demonstrating empathy, and resolving problems swiftly.

Direct Claim Consultant

Hancock Claims Consultants
05.2018 - 11.2018
  • Ensured accurate documentation of property claims, facilitating smooth communication between all parties involved.
  • Conducted day-to-day administrative tasks to maintain information files and process paperwork.
  • Enhanced customer satisfaction by efficiently managing property claims and providing timely resolutions.
  • Reviewed questionable claims by conducting agent and claimant interviews to correct omissions and errors.
  • Collaborated with insurance adjusters to accurately assess property damage and determine appropriate compensation.
  • Coordinated with contractors and vendors for prompt repair or replacement of damaged properties, minimizing downtime for clients.
  • Assisted clients in navigating the complexities of the insurance claim process, providing clear explanations and guidance when needed.
  • Investigated and assessed damage to property and reviewed property damage estimates.
  • Worked with Xactimate and understanding scopes for estimates of the client's property

Tax Specialist/Temp Worker

The Hartford
11.2017 - 03.2018
  • Maintained thorough and current understanding of applicable tax laws.
  • Enhanced client satisfaction by providing thorough tax analysis and recommendations.
  • Provided clear explanations of complex tax concepts to clients, ensuring they fully understood their responsibilities and obligations.
  • Collaborated with clients to answer questions and provide advice on tax matters.
  • Maintained compliance by adhering to current tax laws and regulations.
  • Identified potential audit red flags to minimize risk of IRS audits.
  • Worked with individuals, trusts and companies to manage tax compliance and reporting needs.
  • Collaborated with cross-functional teams to ensure seamless communication and coordination on tax-related matters.

Customer Service Representative

Centene
08.2016 - 05.2017
  • Delivered exceptional customer service to every customer by leveraging extensive knowledge of products and services and creating welcoming, positive experiences.
  • Promptly responded to inquiries and requests from prospective customers.
  • Supported patients by providing clear explanations on insurance benefits, coverage limitations, and out-of-pocket costs.
  • Performed patient scheduling and registration functions to serve as initial contact point for medical office visits.
  • Obtained patient's insurance information and determined eligibility for benefits for specific services rendered.
  • Coordinated patient's care by facilitating caregiver access to medical home providers and resources to meet patient needs.
  • Maintained up-to-date knowledge of product and service changes.
  • Evaluated patients' financial status and established appropriate payment plans.
  • Coordinated with other departments to address any discrepancies or concerns related to charge capture or data entry accuracy.
  • Examined patients' insurance coverage, deductibles, insurance carrier payments and remaining balances not covered under policies when applicable.

Education

No Degree - Adjusters License 620

Webce
Dallas, TX
12.2021

No Degree - Insurance 2-15 License

Xcel Solutions
Jacksonville, FL
01.2021

High School Diploma -

Seminole State College of Florida
Sanford, FL
05.2003

Skills

  • Records Maintenance
  • Policy Interpretation
  • Benefits analysis
  • Compensation Structuring
  • Claims Processing Software
  • Claims
  • Records Management
  • Data Entry
  • FMLA Administration
  • Attention to Detail
  • Documentation And Reporting

Certification

  • 2-15 License - January 2021- current
  • 620 License- December 2021- current

Timeline

Health Benefits Advisor

United Healthcare
05.2021 - Current

Patient Care Coordinator

AllianceRx Walgreens Prime
10.2020 - 05.2021

Direct Claim Consultant

Hancock Claims Consultants
05.2018 - 11.2018

Tax Specialist/Temp Worker

The Hartford
11.2017 - 03.2018

Customer Service Representative

Centene
08.2016 - 05.2017

No Degree - Adjusters License 620

Webce

No Degree - Insurance 2-15 License

Xcel Solutions

High School Diploma -

Seminole State College of Florida

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