CHRISTYL SIMS
Summary
Detail-oriented professional with excellent communication, interpersonal and creative thinking skills. Aiming to leverage my abilities to successfully fill the vacancy at your company. Frequently praised as hardworking by my peers. I can be relied upon to help your company achieve its goals.
Overview
8
8
years of professional experience
Work History
Claims Resolution Specialist
Claritev
09.2025 - Current
- Manages a high volume of healthcare claims thoroughly to maximize savings opportunities on each claim within the established department production standards and individual goals by contacting provider on all assigned claims and presenting a proposal while maintaining high quality standards.
- Initiate provider telephone calls as often required with respect to proposals, overcome objections and apply effective telephone negotiation skills to reach successful resolution on negotiated claims.
- Meet and maintain established departmental performance metrics.
- Ensure compliance with HIPAA protocol.
- Built strong relationships with clients to understand their needs and provide tailored solutions.
- Achieved successful negotiation outcomes by employing effective communication and active listening skills.
Client Billing Service Representative
Thriveworks Counseling And Coaching
02.2023 - 06.2025
- Engaged in conversation with customers to understand needs, resolve issues and answer product questions.
- Collected deposits or payments and arranged for billing.
- Adjusted bills and refunded money to resolve customers' service or billing complaints.
- Promoted high customer satisfaction by resolving problems with knowledgeable and friendly service.
- Verified patient insurance coverage, created financial plan according to treatment schedules for collections and communicated between patient and billing company regarding health insurance.
- Submitted claims to insurance companies and researched and resolved denials and explanations of benefit rejections.
- Verified that patients had proper insurance coverage prior to procedures or appointment scheduling.
- Determined estimated self-pay portion by calculating charges, co-insurance and deductibles.
- Adhered to HIPAA requirements to safeguard patient confidentiality.
Customer Service Representative
First Light Home Care
GA
04.2018 - 01.2023
- Provided account information to customers and explained bill service policies and customer rights.
- Delivered personalized customer service relating to questions and promptly resolved basic problems on customer accounts.
- Responded to telephone inquiries and complaints following standard operating procedures.
- Investigated and researched issues to determine root causes and appropriate resolution methods.
- Addressed customers courteously using suitable methods and problem-solving skills.
- Data entry and payment processing.
Education
High School Diploma -
East Orange Campus High School
06.2008
Skills
- Understanding customer needs, Customer Data Confidentiality
- Teamwork and Collaboration
- Inbound and Outbound calling
- Billing Adjustments and Refunds
- Account Management
- Data Entry
- Salesforce (CRM), Customer Relationship Management (CRM)
- Open-mindedness
- Negotiation management
- Prepare agreements
- Professional demeanor
Timeline
Claims Resolution Specialist
Claritev
09.2025 - Current
Client Billing Service Representative
Thriveworks Counseling And Coaching
02.2023 - 06.2025
Customer Service Representative
First Light Home Care
04.2018 - 01.2023
High School Diploma -
East Orange Campus High School