Damaris Pickard
Summary
Seasoned insurance specialist with excellent planning and problem solving abilities. Offering several years of experience and a willingness to take on any challenge. Organized, driven and adaptable professional with successful history managing high caseloads in fast-paced environments. Experienced professional with a strong background in technology-related roles. Proficient in software development, system administration, and technical support. Skilled in problem-solving and optimizing performance. Capable of managing projects and collaborating effectively with teams. Committed to continuous learning and staying current with industry trends to contribute to organizational success.
Overview
7
7
years of professional experience
Work History
Claims Support Specialist
Oscar Health
, AZ
12.2021 - Current
- Investigated complex or high-value claims to identify discrepancies and fraud indicators.
- Investigated and resolved discrepancies related to claim payments or denials.
- Compiled statistical information for use in preparing reports that analyze trends in claims processing.
- Processed requests for refunds or adjustments due to overpayments or other errors.
- Developed relationships with external stakeholders such as medical providers, law firms.
- Generated reports on claim trends, cost analysis, productivity metrics. as needed.
- Conducted quality assurance reviews of completed files prior to submission for final approval.
- Analyzed complex cases requiring special attention to determine the best course of action.
- Adjusted and claims under close supervision of more experienced claims team members.
- Monitored reports to identify claims issues and worked with adjusters to resolve problems.
- Handled billing related activities focused on medical specialties.
- Examined claims, records and procedures to grant approval of coverage.
Claims Processing Specialist
Adventist Health System
, FL
10.2017 - 10.2021
- Adhered to HIPAA privacy standards when handling confidential patient information.
- Assisted with developing departmental processes that improved overall efficiency.
- Identified trends in denials by analyzing reports from the system database.
- Verified eligibility, benefits, authorization requirements for services rendered.
- Performed data entry into various systems related to claims processing tasks.
- Documented claim processing activities in accordance with established procedures.
- Reviewed submitted documentation from providers for completeness prior to submitting claims.
- Retained strong medical terminology understanding in effort to better comprehend procedures.
- Organized information by using spreadsheets, databases or word processing applications.
Education
Public Relations
Barry University
Miami, FLSkills
- Claims Processing
- Insurance knowledge
- Medical Terminology
- Financial Transactions
- Data transcription
- Account management expertise
- Skilled in Jira
- Client Interviews
- Customer Service
Timeline
Claims Support Specialist
Oscar Health
12.2021 - Current
Claims Processing Specialist
Adventist Health System
10.2017 - 10.2021
Public Relations
Barry University