Charita Green
Grand Prairie,TX
Summary
Extremely motivated and skilled candidate seeking a position that gives me the opportunity to develop and utilize my experience in the insurance industry. I have many years of experience as well as the ability to perform various responsibilities at an effective rate.
Experienced with evaluating insurance claims to ensure compliance with policies and regulations. Utilizes strong analytical skills to identify discrepancies and facilitate accurate resolutions. Track record of maintaining detailed records and providing exceptional customer service.
Professional in insurance sector with robust background in claims analysis. Known for meticulous approach to examining claims and supporting team objectives through effective collaboration. Reliable and adaptable, consistently contributing to process improvements and accurate claims resolutions. Proficient in problem-solving and critical thinking.
Overview
13
13
years of professional experience
Work History
Sr. Auto/Property Claims Analyst
State Farm
10.2022 - Current
- Handle claims from initial contact through to conclusion.
- Thoroughly investigates claims and verifies eligibility.
- Responsible for maintaining positive customer relationships seeking to enhance organizational skills.
- Manage a high call volume with exception, communication, and customer service skills.
- Ability to work independently and in a team environment.
- Skillfully adapts and uses critical thinking and problem-solving issues in a fast-paced environment.
- Communicates and interacts with a variety of individuals including insureds and claimants; verbally and in writing explains benefits, coverages fault, and claims process, in compliance with regulatory and statutory requirements.
- Handle simple to moderate complexity claims, including single vehicle and multivehicle losses with either clear liability or moderate liability or coverage investigations.
- Document, verify, and review damages as well as make timely payments to insureds, claimants, and shops.
- Daily contact with independent and other carrier adjusters, appraisers, insureds, claimants, attorneys, vendors, agents, and other related parties.
- Analyze, review, and interpret policies to access coverage liability, value, and loss.
CSR2 ISMG
BCBS of Michigan
12.2021 - 09.2022
- Obtaining releases, proofs of loss or compensation agreements and issues company drafts in payments for claims.
- Escalate claims to adjustment teams, rework processors, and subject matter experts follow standard operating procedures to process claims and payment information.
- Analyzed and processed workers' compensation claims by conducting detailed investigations, determining compensability, exposure, and benefits owed to the injured worker.
Sr. Intake Coordinator/Discharge Verification
CIGNA HEALTHSPRING STARPLUS
06.2019 - 11.2021
- Admission of incoming clients which included orientation of HIPPA, Patients Rights, and other Confidentiality laws as required.
- Assisted in the verification of insurance claims such as Medicare, Medicaid, HMOs, and private pay plan, processed and submitted documents as required by Intracare.
- Organizing and retaining files and records, monitoring due dates on action items, establishing follow-up mechanisms and control systems, coordinating time and attendance records, and organizing office supply orders and other minor purchases.
Patient Intake Coordinator
EQ HEALTH SOLUTIONS
03.2019 - 05.2019
- Ensures all intake data for admissions requests are collected and operating procedures and in compliance with all regulatory requirements.
- Enter new patient information into the system Developed an assessment of the patient's problem based on an over-the-phone conversation with the patient.
- Interviews patient's, patient's representative, or referral source to obtain the necessary personal and financial for admission.
Patient Billing Assistant
PROPATH
07.2018 - 02.2019
- Handle day-to-day medical billing procedures by completing HCFA 1500 claim forms and billing insurance companies for reimbursement of services rendered by Physicians.
- Prepare and process patient reimbursements to ensure receipt of payments from insurance/third parties/patients.
- Working directly with the insurance company, healthcare provider, and patient to get a claim processed and paid.
Patient Service Representative
TOUCHSTONE MEDICAL IMAGING
05.2015 - 07.2018
- Achieved high-performance evaluations for call handling ability and quality of services provided to patients in a fast-paced, high-volume call center.
- Assisted patients with all aspects of insurance billing resolution or payments and documented any information or conversations on the computer regarding the patient's accounts.
- Executed excellent customer service and communication skills by verifying and collecting appropriate information, scheduling and registering, and recording patient data in an expedient and accurate manner.
Customer Service Call Center Representative
HCA PATIENT ACCOUNT SERVICES
02.2012 - 09.2014
- Maintain a high-volume workload within a fast-paced environment. Assisted an average of 550 clients in any given week and consistently met performance benchmarks in all areas (speed, accuracy, and volume).
- Listening to patient's requests and taking the appropriate action to respond to the request including, but not limited to scheduling appointments, electronic transmission of messages to the clinical team, and medication requests.
- Utilize automated computer software to take messages for physician offices, and effectively communicate such information to the appropriate party per established protocols or rules of the client.
Education
High School Diploma -
South Grand Prairie High
Grand Prairie, TXSkills
- Microsoft Word, Excel, Outlook, PowerPoint
- Spread Sheet, Account Receivable, Data Entry, Customer Service
- Medical Reception/Front Office, Patient Scheduling, ICD 10, CPT
- Medical Terminology, Medicaid, Medicare, Commercial Insurance, NPI
- Registry, NDC, RX-Lookup, 10 key, RIS, Inteviewer
- Internet, ARA
- Portal, Authpal, Passport, Workers Comp Claims, LOP Claims
- Insurance Verification, Billing and Collections, Payment Posting, Zirmed
- Instamed, Telcore, Care Coordinator, QNX7, Epic, Skype, Webex
- Greenway, Provider Flow(fax), Phreesia (payment), Waystar(estimates)
- AIM, Acuity, Availity, EncoderPro360, Evicore
- Ncompass
- Metavance
- WebDenis
- OptumRx
- ACI payment system Content Manager
- Benefit Explainer Availity
- Cisco Finesse phone BCBS Member
- Portal Alation
- BlueSquared
- Claims analysis
- Interpersonal and written communication
- Policy interpretation
- Claim investigation
- Skilled in software
- Claims review
- Claims history analysis
- Claims trend analysis
- Claims processing
- MS office
- Critical thinking
- Customer service and support
- Computer skills
- Active listening
- Records review
- Decision-making
- Claim form analysis
- Team collaboration
- Denied claims identification
- Settlement negotiations
- Coverage determination
- Certified claims professional
- Benefits review
- Healthcare common procedures coding system (HCPCS)
- Database management
- Fraudulent claims investigation
- Claims evaluation
- Staff management
- Report and records review
- Claims investigation
- Accredited claims professional (ACP)
- Policy analysis
- Payment processing
- Regulatory compliance
- File and record management
- Damage itemization
- Coverage assessment
- Sourcing and compiling information
- Casualty and property loss
- Claims adjustment
- Property damage assessment
- Accredited claims professional
- Policy writing
- Automobile claims specialist
- Accredited claims adjuster (ACA)
- Liability determination
- CCC reports
- Policy investigations
- Damage assessment
- Teamwork
- Teamwork and collaboration
- Customer service
- Problem-solving
- Insurance policy knowledge
- Attention to detail
- Time management
- Problem-solving abilities
- Multitasking
- Multitasking Abilities
- Reliability
- Data interpretation
Timeline
Sr. Auto/Property Claims Analyst
State Farm
10.2022 - Current
CSR2 ISMG
BCBS of Michigan
12.2021 - 09.2022
Sr. Intake Coordinator/Discharge Verification
CIGNA HEALTHSPRING STARPLUS
06.2019 - 11.2021
Patient Intake Coordinator
EQ HEALTH SOLUTIONS
03.2019 - 05.2019
Patient Billing Assistant
PROPATH
07.2018 - 02.2019
Patient Service Representative
TOUCHSTONE MEDICAL IMAGING
05.2015 - 07.2018
Customer Service Call Center Representative
HCA PATIENT ACCOUNT SERVICES
02.2012 - 09.2014
High School Diploma -
South Grand Prairie High
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