Chanelle Thornton
Tampa,FL
Summary
Experienced with analyzing and processing claims with precision and care. Utilizes effective communication to ensure clarity and resolution of claims. Track record of maintaining high accuracy and compliance standards.
Professional, skilled in claim processing and prepared for this role. Demonstrates strong analytical abilities, attention to detail, and expertise in managing complex claims. Known for fostering team collaboration and consistently achieving high-quality results. Adaptable and reliable, with focus on customer satisfaction and compliance.
Efficient claims professional with proven track record of managing and resolving complex claims. Known for driving process improvements and maintaining high standards in accuracy and compliance. Highly focused on team collaboration and adaptability to changing needs.
Overview
12
12
years of professional experience
1
1
Certification
Work History
Senior Claim Processing Specialist
Metlife
Remote
02.2024 - Current
- Led claim processing initiatives to enhance operational efficiency and minimize turnaround time.
- Mentored junior specialists on best practices for accurate claim assessment and documentation.
- Analyzed complex claims to ensure compliance with regulatory standards and company policies.
- Implemented process improvements that reduced errors in claims adjudication by streamlining workflows.
Claims Case Manager
Maxim Healthcare Services, Inc
Remote
02.2022 - 02.2024
- Improved claim accuracy by identifying and correcting omissions and errors through targeted interviews with agents and claimants. Enhanced claim resolution by thoroughly evaluating, investigating, and negotiating settlements on new and pending cases. Achieved effective claim settlements through strategic negotiation and comprehensive claim analysis.
- Analyzed incoming files to ascertain current claim status and devise effective response strategies.
- Analyzed data from attending physician and employer to determine claimant eligibility for benefits.
- Evaluates and processes LTD and STD claims within assigned caseload, applying criteria to decide on suspension, termination, or payment of claims.
- Managed complex claims processing to ensure compliance with regulations and company policies.
- Evaluated claim submissions, identifying discrepancies and initiating timely resolutions.
Insurance Specialist-WAH
GTE Federal Credit Union
Tampa, FL
11.2020 - 02.2022
- Executed thorough preparation and review of insurance applications to ensure regulatory compliance.
- Executed comprehensive application processes to achieve underwriting approval for coverage.
- Managed client relationships through effective utilization of CRM software, ensuring streamlined communication and engagement.
- Conducted prompt investigations and streamlined claims processing to ensure high levels of customer satisfaction.
- Managed insurance claims processing, ensuring compliance with regulations and policies.
- Evaluated member insurance needs, providing tailored product recommendations to enhance coverage.
Auto, Insurance Claims Rep
Progressive
Tampa, FL
02.2020 - 11.2020
- Analyzed complex data and prepared accurate and comprehensive reports for clients.
- Successfully negotiated settlements with claimants and insurers.
- Negotiated with claimants to settle claims.
- Assessed complex claims and accurately determined value of damages.
Billing & Collections Agent
JP Morgan Chase
Tampa,FL
05.2019 - 02.2020
- Assist members with opening checking, saving, and safe deposit boxes
- I also helped manage accounts, and perform maintenance on accounts
- Process transactions, such as, Deposits, Fund transfers, Withdrawals, and Check statuses
- Report any and all fraudulent/ suspicious activities
- Greet and identify any concerns the customer may have
- Also process payment for customers for mortgage, credit cards
- Initiate and approve or deny Wire transfers.
Claims Representative
Humana Inc
Tampa, FL
08.2015 - 04.2019
- Generated, posted and attached information to claim files.
- Answered incoming phone calls to articulate product value to prospective customers and support current policyholders.
- Resubmitted claims after editing or denial to achieve financial targets and reduce outstanding debt.
- Worked productively in fast-moving work environment to process large volumes of claims.
Insurance Verification Specialist
Health Plan Services
Tampa, FL
03.2014 - 06.2015
- Completed administrative patient intakes with case histories, insurance information and mandated forms.
- Achieved insurance pre-authorizations to enable timely patient procedures.
- Identified and resolved patient billing and payment issues.
- Researched CPT and ICD-9 coding discrepancies for compliance and reimbursement accuracy.
Education
High School Diploma -
Freedom High School
Tampa, FL2011
Skills
- Time management mastery
- Process improvement strategies
- CPT coding proficiency
- Claims
- Policy interpretation
- Insurance regulations
- Active listening
- Task prioritization
- Professionalism
- Written communication
- Billing software
- Regulatory compliance adherence
- Client interviews
- Liability management
- Reporting
- Microsoft Word
- Computer skills
Certification
NMLS -May 2019
Timeline
Senior Claim Processing Specialist
Metlife
02.2024 - Current
Claims Case Manager
Maxim Healthcare Services, Inc
02.2022 - 02.2024
Insurance Specialist-WAH
GTE Federal Credit Union
11.2020 - 02.2022
Auto, Insurance Claims Rep
Progressive
02.2020 - 11.2020
Billing & Collections Agent
JP Morgan Chase
05.2019 - 02.2020
Claims Representative
Humana Inc
08.2015 - 04.2019
Insurance Verification Specialist
Health Plan Services
03.2014 - 06.2015
High School Diploma -
Freedom High School
References
Available Upon Request