Summary
Overview
Work History
Education
Skills
Websites
References
Timeline
Generic

Courtney Merjil

Visalia,Ca.

Summary

Experienced Senior Claims Representative with a strong track record in claims processing and customer service. Demonstrated expertise in managing complex claims and resolving customer issues, consistently delivering excellent service with a focus on efficiency and satisfaction. Adept at team leadership and maintaining strong client relationships.

Overview

14
14
years of professional experience

Work History

Senior Claims Representative

Cigna
Visalia
08.2018 - Current

• Review and processed medical claims for accuracy, completeness, and adherence to insurance policies and guidelines

• Investigate and resolve complex claim issues by analyzing medical records, policy documents, and billing information

• Identify potential fraudulent activities or billing errors through careful analysis of claims data

• Maintain a high level of productivity while meeting quality standards in processing a large volume of claims daily

• Utilize coding systems such as CPT, ICD-10, HCPCS to accurately assign appropriate reimbursement codes for services rendered

• Assist in the development and implementation of new processes to improve efficiency in claims processing workflow

• Perform audits on process claims to identify trends or patterns that may require further investigation or process improvement

• Maintain accurate documentation of all actions taken during the claims review process for audit purposes

Manager

Pizza Factory
Visalia
08.2013 - Current
  • Train and supervise kitchen and service staff
  • Oversee compliance with sanitation, safety and food preparation
  • Keep dining and kitchen clean and organized
  • Engage with customers to ensure satisfaction
  • Handle customer complaints and deescalate any issues that may arise
  • Close all registers at end of day and verify all registers and safes have the correct amounts

Customer Service Representative

California Check Cashing Stores, LLC.
Visalia
06.2017 - 08.2018
  • Provide excellent customer service
  • Process various transactions for customers including deposits, withdrawal's, check cashing and loan payments
  • Operated cash registers and time delay safe with large amount of cash
  • Promote services to customers such as loans, check cashing, debit card and tax services
  • Verify checks for accuracy prior to issuing funds
  • Ability to identify fraudulent checks and other possible fraudulent transactions
  • Determine customer eligibility for loan products
  • Perform marketing duties such as going to other businesses and leaving flyers with the services we provide and also make outbound calls for former customers to inform of the products we offer

Customer Service/Cashier

Pizza Factory
Porterville
02.2011 - 02.2013
  • Provide excellent service to guests
  • Maintained a clean and organized work environment
  • Prepared sauces/salads/pastas etc
  • Trained new hires in food preparation.

Education

High School Diploma -

Porterville Adult School
Porterville, CA
04.2010

Skills

  • Customer Service
  • Data Entry
  • Leadership
  • Adaptability
  • Research and reporting
  • Microsoft and Excl
  • Problem Solving
  • Training
  • Time management
  • Self-Motivated
  • Ability to type 40 WPM

References

  • Cindy Perez, Current Supervisor, Cigna Supplemental Benefits, 5300 W Tulare Ave, Visalia, CA, 93277, (559) 759-7449
  • Paulina Vath, Former Co-worker, 40 N Corona Drive, Porterville, CA, 93257, (559) 719-7933
  • Ilene Gonzalez, Owner, Pizza Factory, 3121 W Noble Ave, Visalia, CA, 93277, (559) 737-2969
  • Ana Barajas, Former Co-worker, 3121 W Noble Ave, Visalia, CA, 93277, (559) 759-7809
  • Michelle Nursery, Owner, Pizza Factory, 897 W Henderson Ave, Porterville, CA, 93257, (559) 784-8677

Timeline

Senior Claims Representative

Cigna
08.2018 - Current

Customer Service Representative

California Check Cashing Stores, LLC.
06.2017 - 08.2018

Manager

Pizza Factory
08.2013 - Current

Customer Service/Cashier

Pizza Factory
02.2011 - 02.2013

High School Diploma -

Porterville Adult School
Courtney Merjil