Clark Stallworth
New York,NY
Summary
Qualified and well versed in insurance service, policy assistance, billing, claims, verifying information and managing settlements in healthcare and automotive. Friendly and upbeat team player with organized and disciplined approach. Demonstrates comprehensive understanding of insurance policies and regulations with informed recommendations for appropriate protection options. Passionate cultivator of loyal customer relationships and organizational service quality.
Overview
7
7
years of professional experience
Work History
Clinical Administrator
United Healthcare, UHG
05.2023 - Current
- Established strong relationships with insurance providers, resulting in faster claim processing times for patients.
- Aid remote users via phone, chat, or remote desktop utilities.
- Improved patient satisfaction by streamlining appointment scheduling and follow-up procedures.
- Reduced operational costs through efficient resource allocation and strategic financial management.
- Implemented electronic health record systems, ensuring accurate documentation and easy access to patient information.
Claims Specialist
Lincoln Financial Group
01.2022 - 01.2023
- Expedited claim settlements by maintaining open lines of communication with all parties involved, fostering trust, and ensuring a smooth process.
- Improves client satisfaction ratings by addressing issues and fostering timely resolution with customers on first contact
- Check levels and types of coverage and evaluate coverages
- Productively works in fast-moving work environment to process large volumes of cases and calls daily
- Improved departmental workflow by implementing best practices in claims handling procedures, leading to more accurate assessments and quicker resolutions.
Intake Coordinator
Healthfirst
01.2020 - 08.2020
- Ensured continuity and quality service both internally and to potential members for document submission with the State Department of Health and HRA to provide managed long-term care along with other health plans
- Verified Medicaid and Medicare eligibility for prospective clients Managed financial documentations such as expense reports and invoices
- Completed medical necessity checks when Medicare was the payer using diagnosis and procedure codes provided on the physicians' order
- Prepared evaluation package for state entities
- Completed medical and behavioral health assessments.
Managed Care Specialist
Fidelis Care
06.2019 - 01.2020
- Devised and introduced initiatives and projects to maintain or improve existing facilities, allowing for maximization of capital component of Medicaid's per diem rate
- Configure email accounts and troubleshoot mobile app problems.
- Coordinated collection activities for delinquent accounts by preparing information for external collection agencies
- Worked closely and regularly with Case Management to follow up on in-house patients whose financial situation
- Completed member evaluations to align with state and program guidelines Developed and updated policies and procedures, maintaining compliance with statutory, regulatory, and local, state, and federal guidelines relating to HIPAA, and benefits administration
- Communicated with patients, provided great customer service, ensuring that medical information was kept private
- Minimized risks under the company's established policies Completed long-term care assessments within medical and behavioral health accounts
- Investigated and determined information relative to insurance verification of account-specific patient admissions
Underwriting Assistant
State Farm
07.2017 - 04.2019
- Manage password resets and access permissions for agents nationwide.
- Identify and resolve hardware-related issues for agents and staff.
- Communicated with customers in a courteous manner using approved scripts via phone or written correspondence
- Responded to customer needs through competent customer service and prompt problem-solving
- Updated customer accounts and system database with latest details to support accuracy and efficiency in future interactions
- Provided excellent customer relations by providing top-notch service and detailed order, account, and service information
- Maintained accurate and current customer account data with manual forms processing and digital information updates.
Assistant Manager
Meritage
12.2016 - 08.2017
- Served as an assistant manager responsible for overseeing and managing a team of more than twenty individuals.
- Implemented regular one-on-one coaching sessions, performance evaluations, corrective action and constructive criticism to help them improve their skills to better assist customers and increase productivity.
- Exceeded sales goals and accomplished business objectives by inspiring staff and promoting target products.
- Implemented regular one-on-one coaching sessions, performance evaluations, corrective action and constructive criticism to help them improve their skills to better assist customers and increase productivity
Education
Bachelor of Science - Marketing
Georgia State University
Atlanta, GA12.2024
Associate of Science - Business Administration
Georgia State University
Atlanta, GA05.2018
Skills
- Claim investigation
- Claims analysis
- Efficient and Detail-Oriented
- Policy analysis
- Data analysis and entry
- Expert Mathematical & Analytical Ability
- Interpersonal skills
- Conflict resolution
- Adaptability
- Decision-Making
- Claims Evaluation
- Clear communication
- Technical Troubleshooting
- Software Installation
Volunteer Work
90+, John B. Amos Cancer Center
Timeline
Clinical Administrator
United Healthcare, UHG
05.2023 - Current
Claims Specialist
Lincoln Financial Group
01.2022 - 01.2023
Intake Coordinator
Healthfirst
01.2020 - 08.2020
Managed Care Specialist
Fidelis Care
06.2019 - 01.2020
Underwriting Assistant
State Farm
07.2017 - 04.2019
Assistant Manager
Meritage
12.2016 - 08.2017
Bachelor of Science - Marketing
Georgia State University
Associate of Science - Business Administration
Georgia State University
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