Cloveese Moore
Fort Worth,TX
Summary
Dynamic ES Specialist with proven expertise in medical claims processing at Maximus. Adept at evaluating insurance coverage and ensuring compliance, I excel in client account management and documentation accuracy. Recognized for exceptional problem-solving skills, I consistently achieve high customer satisfaction ratings through effective communication and attention to detail.
Overview
13
13
years of professional experience
1
1
Certification
Work History
Enrollment/Claims Processor
Newstart Inc
Fort Worth, TX
07.2025 - Current
- Investigates, evaluates, and settles medical insurance claims by reviewing policies, examining bills/records, determining coverage and resubmission of claims to clients insurance on file
- Processed incoming claims by reviewing documentation and verifying information.
- Evaluated claim requests and ensured compliance with company policies.
- Communicated with clients to gather necessary information for claim processing.
- Reviewed and verified insurance policy information to assess coverage and determine appropriate claims processing procedures.
ES Specialist Data Entry
Maximus
McLean, VA
10.2023 - 07.2025
- Process Medical Claims for the State of Arkansas
- Investigates, evaluates, and settles claims by determining coverage.
- Update the claim and Program client is receiving and also back date for prior months if needed
- Process claims send over to a third party to be reviewed further for determination
- Document each claim case and actions taken on the claim case and submit over to Supervisor for review
ES Specialist Data Entry
Incomna
Fort Worth, TX
08.2022 - 10.2023
- Process Medical Claims for the State of Arkansas
- Investigates, evaluates, and settles claims by determining coverage.
- Update the claim and Program client is receiving and also back date for prior months if needed
- Process claims send over to a third party to be reviewed further for determination
- Document each claim case and actions taken on the claim case and submit over to Supervisor for review
Collections
Bread Financial
, Remote
12.2022 - 09.2023
- Keep track of assigned accounts to identify outstanding debts.
- Plan course of action to recover outstanding payments.
- Locate and contact debtors to inquire about their payment status.
- Negotiate payoff deadlines or payment plans
- Confirmed or negotiated payment arrangements.
- Documented account information and payment arrangements on Computer.
- Conducted all conversations in a clear, friendly, and professional manner.
- Completed phone calls to meet required performance standards
Customer Advocate I
TTEC
Fort Worth, TX
10.2021 - 08.2022
- Researched and resolved accounts and claims.
- Investigates, evaluates, and settles claims by determining coverage.
- Process claims send over to a third party to be reviewed further for determination
- If client denied sent out proper documentation
- Document each claim and actions taken on the claim and submit over to Supervisor for review
Customer Advocate I
Support Services Group
Waco, TX
11.2020 - 10.2021
- Educated clients on account services and resolved client inquiries regarding statement information and account balances.
- Addressed escalated customer service issues sent from sales and service teams to save customer relationships.
- Resolve customer issues per shift by researching and exploring answers, implementing solutions and escalating unresolved problems to upper management.
- Achieved high satisfaction rating through proactive one-call resolutions of customer issues.
- Troubleshoot devices and also escalate to higher departments to resolve Educated customers on current promotions, upgrades or new offerings available under current plan.
- Described product highlights and benefits to help guide purchasing decisions.
- Delivered excellent customer service, resulting in consistent 95-100% customer satisfaction rating.
Customer Service Representative
Waco Convention Center
Waco, TX
12.2019 - 03.2020
- Confer with customers by telephone or in person to provide information about products or services, take or enter orders, cancel accounts, or obtain details of complaints.
- Keep records of customer interactions or transactions, recording details of inquiries, complaints, or comments, as well as actions taken.
- Check to ensure that appropriate changes were made to resolve customers problems.
- Determine charges for services requested, collect deposits or payments, or arrange billing.
Customer Advocate I
C3Connect /Humana
McGregor, TX
03.2019 - 12.2019
- Provide customer service, such as limited instructions on proceeding with claims or referrals to auto repair facilities or local contractors.
- Review insurance policy to determine coverage. Prepare insurance claim forms or related documents and review them for completeness.
- Contact insured or other involved persons to obtain missing information.
- Post or attach information to claim file. Maintained customer satisfaction with forward-thinking strategies focused on addressing customer needs and resolving concerns.
- Answered customer telephone calls promptly to avoid on-hold wait times.
Cashier/Customer Service
PLS Check Cashiers
Dallas, TX
05.2018 - 03.2019
- Determine customers' financial services needs and prepare proposals to sell services that address these needs.
- Upsell services that we provide as a check cashing company such as prepaid cards, car insurance, notary, or check processing services.
- Contact prospective customers to present information and explain available services.
- Prepare forms or agreements to complete sales.
Dispatcher
Aries Shuttle
Hurst, TX
11.2016 - 05.2018
- Inspect all vehicles prior to leaving the lots of any damages inside and outside of the vehicle.
- Ensure that piolet and flight attendants are picked up at location on time and drop at correct destination.
- Schedule every driver for the day and call and confirm there shift if changes of the shift or the vehicles needs to changed make all necessary changes.
- Make sure to track the DOT Log for the drivers on the road adhere to the policy and the transportation laws.
- Verify if flight are delayed are coming in on time in the system.
Dispatcher/Customer Service
ECS Transportation Group
Carrollton, TX
11.2015 - 12.2016
- Prepare reports on investigations or inspections and actions taken. Issue notices and recommend corrective actions when infractions or problems are found.
- Examine carrier operating rules, employee qualification guidelines, or carrier training and testing programs for compliance with regulations or safety standards.
- Review commercial vehicle logs, shipping papers, or driver and equipment records to detect any problems or to ensure compliance with regulations.
- Investigate and make recommendations on carrier requests for waiver of federal standards.
- Investigate incidents or violations, such as delays, accidents, and equipment failures.
Dispatcher
KCT Group/ Carey Limousine
Kansas City, MO
06.2013 - 11.2016
- Prepare reports on investigations or inspections and actions taken. Issue notices and recommend corrective actions when infractions or problems are found.
- Examine carrier operating rules, employee qualification guidelines, or carrier training and testing programs for compliance with regulations or safety standards.
- Review commercial vehicle logs, shipping papers, or driver and equipment records to detect any problems or to ensure compliance with regulations.
- Investigate and make recommendations on carrier requests for waiver of federal standards.
- Investigate incidents or violations, such as delays, accidents, and equipment failures.
- Made reservation for clients and also arranged transportation for large groups.
- Modified reservation, payment information and pick up and drop off locations.
- Sent out emails to management for nightly shift reports of accidents, vehicle towing, coordinate exchange of vehicle to make sure client got to and from pick and drop off on time.
- Assign driver trips for the next day and call and confirm.
- Upsell additional services such as larger vehicles if needed.
Education
Science (AS) (Associate) -
Heritage College
Kansas City, MO12.2006
Skills
- Medical claims processing
- Claims documentation
- Insurance coverage evaluation
- Client account management
- Data entry accuracy
- Compliance adherence
- Regulatory knowledge
- Attention to detail
- Time management
- Customer relationship management
- Problem solving
- Analytical thinking
- Task prioritization
- Interpersonal communication
- Key performance indicators
- Decision-making
- Multitasking Abilities
Certification
• Driver's License
Personal Information
Willing To Relocate: Anywhere
References
References available upon request.
Timeline
Enrollment/Claims Processor
Newstart Inc
07.2025 - Current
ES Specialist Data Entry
Maximus
10.2023 - 07.2025
Collections
Bread Financial
12.2022 - 09.2023
ES Specialist Data Entry
Incomna
08.2022 - 10.2023
Customer Advocate I
TTEC
10.2021 - 08.2022
Customer Advocate I
Support Services Group
11.2020 - 10.2021
Customer Service Representative
Waco Convention Center
12.2019 - 03.2020
Customer Advocate I
C3Connect /Humana
03.2019 - 12.2019
Cashier/Customer Service
PLS Check Cashiers
05.2018 - 03.2019
Dispatcher
Aries Shuttle
11.2016 - 05.2018
Dispatcher/Customer Service
ECS Transportation Group
11.2015 - 12.2016
Dispatcher
KCT Group/ Carey Limousine
06.2013 - 11.2016
Science (AS) (Associate) -
Heritage College