Danielle Falls
Greer,SC
Summary
Highly organized and detail-oriented worker, with a drive to exceed expectations. Previous roles have enabled me to excel at prioritizing, multitasking efficiently, and utilizing troubleshooting skills to work through roadblocks as I work to achieve success in work-related goals. Skilled in providing high-quality service in a fast-paced work environment, analyzing data, and providing solutions to complex problems. Seeking to leverage skills and knowledge to contribute to team success.
Overview
15
15
years of professional experience
Work History
Applications Specialist
Access TeleCare
07.2023 - 11.2023
- Worked closely with the privileging team to ensure the onboarding, re-appointment, and implementation applications were completed accurately and in a timely manner.
- Processed privileging applications on behalf of physicians
- Ensured all applications were completed both timely and accurately
- Maintained application processing status in physician database
- Maintained physician and hospital files
- Communicated with physicians for any outstanding documents/information needed
- Maintained professional communication with all physicians, coworkers, and management.
- Maintained compliance with Joint Commission credentialing standards and Access TeleCare policies
- Maintained strict confidentiality of all physician files
Benefits Verification Specialist
AmerisourceBergen with Lash Group
11.2020 - 05.2023
- Conducted research to verify insurance coverage eligibility, authorization and other related issues
- Developed, maintained and updated benefit records in the system to ensure accuracy of information
- Handled sensitive customer information in accordance with HIPAA regulations and confidentiality requirements
- Maintained up-to-date knowledge of current healthcare industry trends, practices, laws, regulations and standards of care
- Prepared correspondence letters informing customers of their rights under applicable legal statutes
- Utilized problem solving skills to resolve complex issues related to benefit verification operations
- Ensured that work was completed according to established quality control standards
- Collaborated with external providers such as health plans and pharmacies to obtain required information for verification purposes
- Utilized knowledge of CPT codes, diagnosis codes, and medical terminology
- Accurately took notice of and reported adverse events as directed
- Utilized systems such as Salesforce, Transunion, and CenterX to aid in completion of benefit verifications
- Maintained accurate records of all claim activities in the database system.
Claims Specialist
98 Ventures
11.2019 - 09.2020
- Drafted letters of denial or notification of payment in response to claimant inquiries
- Performed quality assurance checks on outgoing payments for accuracy and completeness
- Prepared detailed summaries of investigations for senior leadership review
- Analyzed claims data to determine appropriate resolution of cases according to company policies and procedures
- Provided customer service to claimants by answering their questions, resolving disputes, and explaining the claims process
- Collaborated with other departments such as Underwriting, Accounting, and Legal when necessary
- Participated in meetings with internal staff members and external customers and vendors regarding complex claims issues
- Tracked trends in claim denials or delays in order to identify areas needing improvement within the organization's processes.
Debt Specialist I
TD Bank
12.2018 - 11.2019
- Mentored new Claims Specialists on best practices and departmental procedures
- Reviewed incoming documentation for completeness prior to processing a claim
- Developed strategies for managing large caseloads efficiently while meeting deadlines
- Managed escalated calls from clients regarding their delinquent accounts
- Demonstrated ability to effectively manage a high volume of customer accounts and maintain accurate records
- Initiated telephone contacts with delinquent customers according to departmental policies and procedures
- Developed strong communication skills, both verbal and written, to interact with customers in a professional manner
- Established positive relationships with customers by providing excellent customer service
- Utilized problem-solving skills to resolve customer disputes promptly and efficiently
- Proficient in using various computer programs such as Microsoft Office Suite and collections software
- Assisted customers with payment arrangements that fit their individual financial needs
- Investigated customer complaints related to billing errors or discrepancies in a timely manner
- Applied knowledge of collection laws, regulations, and procedures when collecting on past due accounts.
Senior Teller
Synovus
05.2018 - 11.2018
- Followed security protocols when opening and closing the branch office each day
- Managed multiple currency types including foreign currencies when exchanging money for customers
- Processed loan payments, credit card payments, and other monetary transactions accurately
- Adhered strictly to all federal regulations related to anti-money laundering laws
- Developed strong customer relationships by providing excellent customer service and responding to inquiries promptly
- Balanced cash drawer daily at the end of each shift to ensure accuracy
- Resolved customer complaints quickly and efficiently in order to maintain positive relationships with clients
- Cross-sold bank products to existing customers while meeting sales goals set by management
- Verified the accuracy of customer account information prior to processing transactions
- Utilized banking software programs to process electronic fund transfers between accounts or initiate wire transfers
- Ensured that all customer data was kept confidential according to bank policy standards.
Receptionist
ProSource Plumbing Supply
08.2017 - 03.2018
- Greeted visitors warmly and ensured they had a positive experience
- Utilized Microsoft Office Suite to create professional documents for internal use or external distribution
- Answered phones professionally in accordance with organizational protocols
- Ensured reception area was clean at all times and stocked with necessary supplies
- Scheduled conference rooms for meetings and special events as needed
- Maintained confidentiality of sensitive information obtained through job duties.
Branch Support Specialist
World Acceptance Corporation
07.2016 - 08.2017
- Provided superior customer service by responding to inquiries in an efficient and friendly manner
- Assisted with administrative tasks such as filing documents, copying materials
- Managed daily calendar appointments for staff members
- Operated multi-line phone system efficiently while managing high call volume
- Provided comprehensive customer service and technical support to branch staff and customers
- Coordinated closely with internal departments to ensure successful resolution of customer inquiries
- Participated in ongoing team meetings to discuss progress updates and strategies
- Demonstrated excellent problem-solving skills in resolving customer issues quickly and efficiently
- Trained users on how to effectively use various applications within the organization's systems
- Utilized advanced computer knowledge to troubleshoot hardware and software problems
- Identified areas of improvement in existing processes or procedures
- Developed customized solutions based on individual customer needs
- Ensured compliance with security protocols when handling sensitive information
- Maintained accurate records of all help desk requests, solutions, and follow up activities
- Handled difficult conversations professionally while maintaining composure during high-stress situations
- Attended continuing education courses as required by licensing board to stay abreast of current trends in claims adjusting field.
Rapid Response Associate/Claims Adjuster
Esurance
04.2015 - 07.2016
- Analyzed, evaluated and processed insurance claims to determine coverage, liability and damages in accordance with policy terms and state regulations
- Conducted investigations into the cause of loss or damage, reviewed relevant documents and interviewed claimants to gather evidence
- Performed quality assurance reviews on incoming claims to ensure accuracy of information before proceeding with adjustment process
- Adhered to industry standards related to ethical practices when dealing with sensitive customer information
- Effortlessly handled a high volume of inbound calls
- Provided superior customer service by responding quickly and courteously to inquiries from customers regarding their auto insurance claims
- Evaluated liability decisions to determine if coverage applies to a particular loss or situation
- Processed high volumes of work efficiently while meeting established deadlines
- Resolved customer complaints regarding auto insurance policies promptly and professionally
- Negotiated payment arrangements with customers to ensure timely resolution of delinquent accounts
- Maintained accurate records of collections activity including payments received and payment plans established.
Debt Specialist II
TD Bank
07.2014 - 04.2015
- Conducted research on debtor's financial situation in order to determine the best course of action for collecting past due balances
- Ensured compliance with all applicable laws, regulations, and ethical standards related to collections operations
- Developed strong communication skills, both verbal and written, to interact with customers in a professional manner
- Demonstrated strong problem-solving skills when resolving customer complaints or inquiries
- Assisted customers with online account management including resetting passwords or troubleshooting issues
- Provided exceptional customer service by responding promptly to client requests or questions
- Analyzed customer needs to determine the best banking products and services to meet their requirements
- Advised customers on various banking products such as mortgages, lines of credit, investments
- Developed detailed knowledge of banking regulations and procedures
- Performed data entry for customer accounts and updated records in the database.
Banking Specialist I
TD Bank
02.2013 - 07.2014
- Provided superior customer service by responding to inquiries in an efficient and friendly manner
- Assisted with administrative tasks such as filing documents, copying materials
- Managed daily calendar appointments for staff members
- Operated multi-line phone system efficiently while managing high call volume
- Provided comprehensive customer service and technical support to branch staff and customers
- Coordinated closely with internal departments to ensure successful resolution of customer inquiries
- Participated in ongoing team meetings to discuss progress updates and strategies
- Demonstrated excellent problem-solving skills in resolving customer issues quickly and efficiently
- Trained users on how to effectively use various applications within the organization's systems
- Utilized advanced computer knowledge to troubleshoot hardware and software problems
- Identified areas of improvement in existing processes or procedures
- Developed customized solutions based on individual customer needs
- Ensured compliance with security protocols when handling sensitive information
- Maintained accurate records of all help desk requests, solutions, and follow up activities
- Handled difficult conversations professionally while maintaining composure during high-stress situations
- Attended continuing education courses as required by licensing board to stay abreast of current trends in claims adjusting field.
Teller
Wells Fargo
06.2011 - 02.2013
- Balanced cash drawer daily and resolved discrepancies to provide accurate data regarding cash flow.
- Answered customer inquiries regarding account balances, transaction history, services charges, and interest rates.
- Processed customer transactions promptly, minimizing wait times.
- Maintained in-depth knowledge of bank products and services to provide appropriate recommendations to customers.
- Learned about customer's financial needs, established trust, and optimized sales opportunities resulting in quality customer service.
- Served as primary point of contact for customers, providing assistance with account maintenance and transactions.
- Educated customers on use of banking website and mobile apps.
- Followed up on customer complaints and provided solutions to enhance customer satisfaction.
- Counted, verified and handled bank deposits and armored car transactions.
- Established rapport with new clients to increase satisfaction and loyalty.
- Identified sales opportunities and referred customers to branch partners in financial services.
POS Associate
Kohl's
08.2008 - 09.2011
- Developed strong product knowledge to answer customers' questions about merchandise, pricing, and availability
- Verified that all prices were accurate before ringing up purchases
- Provided excellent customer service by greeting customers, answering their inquiries, and resolving any complaints in a timely manner
- Trained new employees on proper POS system usage and operations
- Answered incoming phone calls promptly and professionally while providing helpful information or directing callers accordingly
- Balanced cash drawer at end of shift for accuracy in accordance with established procedures
- Processed returns and exchanges following company policies while providing exceptional customer service
- Packaged and bagged goods for customer convenience
- Issued gift receipts when requested to provide recipients with easy return options
- Monitored checkout area to identify possible thefts.
Education
High School Diploma -
Pendleton High School
Pendleton, South Carolina05.2007
Skills
- Customer Support
- Quality Standards
- Compliance Management
- Settlement Determinations
- Documentation Review
- Claims
- Eligibility Determination
- Data Entry
- Customer Service
- Decision-Making
- Attention to Detail
- Policy and Procedure Explanations
Timeline
Applications Specialist
Access TeleCare
07.2023 - 11.2023
Benefits Verification Specialist
AmerisourceBergen with Lash Group
11.2020 - 05.2023
Claims Specialist
98 Ventures
11.2019 - 09.2020
Debt Specialist I
TD Bank
12.2018 - 11.2019
Senior Teller
Synovus
05.2018 - 11.2018
Receptionist
ProSource Plumbing Supply
08.2017 - 03.2018
Branch Support Specialist
World Acceptance Corporation
07.2016 - 08.2017
Rapid Response Associate/Claims Adjuster
Esurance
04.2015 - 07.2016
Debt Specialist II
TD Bank
07.2014 - 04.2015
Banking Specialist I
TD Bank
02.2013 - 07.2014
Teller
Wells Fargo
06.2011 - 02.2013
POS Associate
Kohl's
08.2008 - 09.2011
High School Diploma -
Pendleton High School
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