Summary
Overview
Work History
Education
Skills
Timeline
Generic

Cartilya Harrington

Ellenwood,GA

Summary

Extremely motivated and detail-oriented Licensed Claims Adjuster with years of experience in providing a superior level of customer service. Strong communication skills with the ability to work efficiently both individually and in a fast-paced team environment. Skilled in the ability to investigate claims quickly and accurately and resolve them in compliance with corporate and regulatory guidelines. Strong knowledge of insurance policy coverage and exceptional attention to detail. I'm committed to using my experience and expertise to provide accurate and timely claim resolution. Organized and detail-oriented Investigator dedicated to improving efficiency, productivity and profitability through continuous process improvement. Analytical thinker skilled at developing innovative solutions to complex problems.

Overview

18
18
years of professional experience

Work History

Property and Auto Desk Adjuster

Alacrity Solution
11.2022 - Current
  • Analyzed coverage and investigated and resolved claim issues for first and third parties.
  • Coordinated repair services for damaged vehicles and assist with rental and rental reimbursements
  • Determined liability of claims for personal and commercial auto.
  • Reviewed all necessary documentation, such as statements, police reports, appraisal reports, filed inspections, estimates and photos.
  • Responded to customer inquiries, made appropriate decisions and closed files.
  • Developed strong relationships with policyholders by providing exceptional customer service throughout the claims process.
  • Answered insured questions regarding deductibles, premiums, policy coverage.
  • Issued settlement payments.

Workers Comp AR/Appeal Specialist

Wellstreet (Piedmont Urgent Care)
11.2020 - 11.2022
  • Perform timely follow-up activities on partial payments and denials for Workers Comp claims
  • Process appeals to health insurance by Fax/Upload to health insurance web portal/ or mail
  • Contact Insurance Company to determine why claims are not paid and take the necessary action for resolution
  • Review Insurance EOR
  • Review 1500 forms
  • Post insurance payments and contractual adjustments
  • Review Medical Records.

Property Desk Claims Adjuster

The Cernry Group
11.2018 - 10.2020
  • Provide strong customer service to policyholders, attorneys, and vendors to expedite claim resolution
  • Research, investigate, review claim information, and update files to closure
  • Investigate claims involving suspected fraudulent activities
  • Follow up and document detailed notes to support the claims decision process
  • Estimate and/or determine coverage based on insurance policy and carrier guidelines
  • Negotiate claim settlement agreements to resolve disputes and issue payments
  • Recognizing appropriateness of settling, compromising or declining coverage
  • Reviewed field inspections and coordinated all insurance claim audits.

Senior Reimbursement AR Specialist

United HealthGroup
04.2011 - 11.2018
  • Perform timely follow-up activities on payments and denials for claims secondary to Medicare
  • Post insurance payments and contractual adjustments
  • Correcting and identifying billing errors and resubmitting claims to insurance carriers
  • Contact Insurance Company to determine why claims are not paid and take the necessary action for resolution
  • Review Insurance EOB’s/UB’s
  • Research under/overpayments/claims
  • Key Medicaid claims
  • Review Medical Records
  • Review Health Insurance contracts to verify if insurance paid per contract rate
  • Process appeals to health insurance
  • Contact/Send letters to patients for additional information needed to process claims.

Senior Billing Specialist

Medical Reimbursements of America
01.2009 - 03.2011
  • 3rd Party Biller for Hospital/Doctors
  • Perform timely follow-up activities on payments and denials for Commercial Health, Medicare and Medicaid to verify receipt of claims and collect and/or provide information to resolve the claim
  • Review and prepare claims for paper/electronic billing submission for Commercial, Medicare, and Medicaid
  • Working closely with hospital facilities, doctor offices, and major insurance companies
  • Correcting and identifying billing errors and resubmitting claims to insurance carriers
  • Follow-up on payment error/low reimbursement
  • Review Appeal letters
  • Print and mail UB92s or HCFA 1500s as necessary for account resolution.

Claims Processing Analyst II

AmMed Direct
10.2006 - 01.2009
  • Follow-up on unresolved claims for Medicare regarding all Diabetic supplies/Denials
  • Contacts Insurance companies to determine why claims are not paid and taking the necessary action for resolution
  • Ability to communicate effectively verbally, writing and speaking with patients, agents, and associates
  • Investigation of health insurance claims and bills to ensure claims resolution
  • Posting insurance payments and contractual adjustments
  • Enter data electronically or paper to process payments, denials, and adjustments.

Education

Certificate of Billing & Coding -

National College of Business & Technology
Nashville, TN

Licensed Independent All Lines Adjuster -

Accredited Claims Adjuster
Galveston, TX

Skills

    Insurance Policy Coverage

    AR

    Appeals

    Claims Management

    Webportals

    Medicare Rt

    Avality

    AltaPoint

    Citrix

    Medical Records/Contract

    Guardwire

    Xactimate

    Customer Service

    Oral & Written Communication skills

    CPT ICD-10/ HCPCS codes

    Epic

    Caremedic

    HCFA 1500/ UB92's

    EFR

    XactAnylisis

    Asris

Timeline

Property and Auto Desk Adjuster

Alacrity Solution
11.2022 - Current

Workers Comp AR/Appeal Specialist

Wellstreet (Piedmont Urgent Care)
11.2020 - 11.2022

Property Desk Claims Adjuster

The Cernry Group
11.2018 - 10.2020

Senior Reimbursement AR Specialist

United HealthGroup
04.2011 - 11.2018

Senior Billing Specialist

Medical Reimbursements of America
01.2009 - 03.2011

Claims Processing Analyst II

AmMed Direct
10.2006 - 01.2009

Certificate of Billing & Coding -

National College of Business & Technology

Licensed Independent All Lines Adjuster -

Accredited Claims Adjuster
Cartilya Harrington