Ceddaja Moore
Charlotte,NC
Summary
Highly-motivated employee with desire to take on new challenges. Motivating and enthusiastic characteristics with over five years of specialization in Customer Service, Sales Associate, Claim Processing, Insurance verification and Case Management experience. Great ability to learn new task quickly and proficiently in a fast past environment. Expertise in growing key customer relationships while maintaining a professional demeanor at all times.
Overview
7
7
years of professional experience
Work History
Proclaim/PMHS Provider Medical Advocate
The Cigna Group
Charlotte, NC
11.2022 - Current
- Proclaim/PMHS skilled
- Provide first call resolution while building strong relationships and delivering accurate account information
- Maintain focused and self motivated work environment
- Review provider claims submissions to ensure processing
- Navigate 4-5 system daily to research, understand, analyze account information
- Educate providers with medical/pharmacy, eligibility, and claim resolution details
- Create inquires/cases for claims to ensure accuracy processing
- Identify opportunities to resolve provider issues timely
- De-escalate ongoing challenging scenario’s
Claims Case Benefit Specialist
AETNA/CVS HEALTH
Charlotte, NC
05.2021 - 10.2022
- Make payment claim decision
- Use medical billing and coding techniques to process claim
- Handle large projects with timely limits
- Efficiently use multiple computer systems and screens at one time to obtain and record claim information
- Process medical claims with little to no supervision within quality and production standards
- Detail oriented with the ability to fast type, effective verbal and written communication skills
- Review claim information to determine the nature of a member's illness or injury
Customer Service Representative
Wells Fargo
Charlotte, NC
09.2019 - 05.2021
- Process withdrawals, loans and loan estimates
- Assist in training/coaching support of new hire team members
- Document interaction and create profile cases to ensure minimum customer effort
- Recommend appropriate solutions and handle confidential information at the highest security
- Manage 401k/retirement account with all questions/processing/inquires.
Human Resource Case Representative
Alight Solutions
Charlotte, NC
08.2017 - 09.2019
- Enroll members into medical, dental, vision, and voluntary benefits
- Explain and answer summary plan description details
- Open and maintain customer accounts by recording account information
- Educated and advised employees on group health plans, voluntary benefits and 401(k) retirement plans.
- Maintain financial accounts by processing customer adjustments
- Resolve product or service problems by clarifying the customer's complaint; determining the cause of the problem; selecting and explaining the best solution to solve the problem; expediting correction or adjustment; following up to ensure resolution
- Ensure company compliance with federal and state laws, including reporting requirements
- Keep records of customer interactions or transactions, recording details or inquires, complains, or comments, as well as action taken
Education
High school or equivalent -
Zebulon B Vance High School
Charlotte, NC01.2016
Skills
- Self motivated
- Multitasking
- Reliable and trustworthy
- Organization skills
- Problem-solving abilities
- Leadership experience
- Adaptability
Timeline
Proclaim/PMHS Provider Medical Advocate
The Cigna Group
11.2022 - Current
Claims Case Benefit Specialist
AETNA/CVS HEALTH
05.2021 - 10.2022
Customer Service Representative
Wells Fargo
09.2019 - 05.2021
Human Resource Case Representative
Alight Solutions
08.2017 - 09.2019
High school or equivalent -
Zebulon B Vance High School