Darian Thomas
Birmingham,AL
Summary
Collaborative individual with expertise in providing exemplary service regarding benefits support. Multitasking Benefits Specialist knowledgeable in state and federal regulations and maintaining employee confidentiality.
Overview
13
13
years of professional experience
1
1
Certification
Work History
Claims Analyst
Blue Cross Blue Shield Of Alabama
Hoover, AL
05.2023 - Current
- Maintained strict confidentiality with all personal data as per company guidelines.
- Managed high-volume caseloads, prioritizing tasks to ensure timely completion of all claims.
- Maintained compliance with industry regulations and company policies while managing sensitive client information and claims records.
- Enhanced customer satisfaction by resolving complex claims issues in a timely manner.
- Conducted thorough investigations into each claim, gathering relevant data and documentation to support decision-making processes.
- Reduced claims processing time by implementing efficient analytical techniques and strategies.
- Provided exceptional customer service by promptly addressing inquiries from policyholders, agents, and other stakeholders regarding the status of their claims.
- Assisted clients throughout the entire lifecycle of their claim, from initial filing to final settlement or denial determination.
Benefits Verification Specialist
Talent Bridge/ Lash Group
Remote
10.2022 - 05.2023
- Manage the TRICARE information program by presenting information utilizing available media, group presentations, or mailings
- Maintain confidentiality of all patient medical information adhering to HIPPA regulations and Medicare /Medicaid policies
- Verify primary insurance eligibility by phone with agents or online regarding Medicaid/Medicare recipients and to determine payment responsibilities to providers
- Verify medical coverage and benefits to providers and members, review certain ICD9 and CPT codes
- Verify patient effective date of insurance, including CPT and diagnosis codes and general policy information
- Receive extensive training on insurance plans and types, HIPAA compliance, Patient Plus programming and other workplace relate topics
- Handle private personal information in accordance with HIPAA regulations
- Handle members personal health information accordingly and follow HIPPA regulations
- Update and maintain patient's demographic information and adhere to HIPPA guidelines/regulations
- Collect insurance information from patients via phone ,fax and email and assist with admissions process and specific program eligibility
- Perform a thorough benefit verification to ensure comprehensive verification for patients regarding coverage requirements and payment levels for the proper therapy.
Operations Manager
Anchor Leg Solutions LLC
Hybrid
11.2018 - 07.2021
- Develop delivery routes and maintain contact with drivers throughout the day
- Collaborate with management to modify daily routes to accommodate the needs of customers
- Act as a communication liaison through the two-way truck radio system and answer incoming phone calls from drivers on the road
- Monitor any sudden route changes or road construction issues and work with drivers to establish new routes for timely deliveries.
- Collaborated with process owners to refine procedures, devise best practices and correct quality audit findings.
- Identified and resolved unauthorized, unsafe or ineffective practices.
- Established positive and effective communication among unit staff and organization leadership, reducing miscommunications and missed deadlines.
- Trained new employees on proper protocols and customer service standards.
- Assisted in recruiting, hiring and training of team members.
- Tracked employee attendance and punctuality, addressing repeat problems quickly to prevent long-term habits.
- Recruited, hired and trained initial personnel, working to establish key internal functions and outline scope of positions for new organization.
- Supervised 200 employees.
Unemployment Claims Specialist
Adecco
Remote
11.2019 - 05.2021
- Makes claims for unemployment insurance benefits by questioning claimants regarding employment history
- Conducts fact finding interviews with claimants to determine if non-separation eligibility requirements have been met
- Determines type and appropriate state and federal unemployment insurance program such as Federal,
- Ex-Service person or Interstate to establish claim based on previous employers, and employment and claim dates
- Verifies accuracy of wage and employer information with claimant; take additional information if claimant indicates wages and/or employers are omitted or incorrect; may request evidence of earnings such as W-2's or wage stubs
- Informs claimant of maximum and weekly benefit amount, basis for computation of benefits, length of claim, maximum allowable earnings and rights and responsibilities while collecting benefits; explains mail-in procedures for receiving benefit checks, issues pay orders and informational materials
- Reviews pay orders completed by claimants receiving benefits on a continuous basis for completeness and reported earning during benefit week; records on claimants master file information such as date, pay order number, and deductions from weekly benefit amount
- Refers claims for eligibility determination to claims deputies
- Enters data on computer terminal, verifies claim and benefit payment information
- Completes and processes forms to stop payment on lost checks, correct computerized claimant information, and recover overpayment of benefits due to revised benefit amount, unreported wages, or duplicate checks issued
- Answers questions from claimants, employers, and Social Service agencies regarding benefit filing procedures, claim status, lost or late checks and appeal rights
- Sorts and files forms, cards, claims files and items of a similar nature; reviews same for errors, omissions and proper coding
- Maintains daily and weekly record or number and type of claims taken and processed
- May receive out-of-state local office claims through electronic mail system; reviews printout for accuracy of data; correct errors and/or omissions.
- Achieved high satisfaction rating through proactive one-call resolutions of customer issues.
Store Manager
CREDIT CENTRAL
Hybird
12.2016 - 10.2018
- Create new schedules in advance for the coming week, which include time off requests
- Train new employees to ensure they understand all the duties of their jobs
- Share information with district managers.
- Reviewed loan files for completeness, identified missing documentation and generated condition lists for applicants.
- Worked with customers in person and via telephone to answer questions, process transactions and resolve issues.
- Negotiated to collect balance in full.
- Processed payments and applied to customer balances.
- Achieved performance goals on consistent basis.
- Maintained high volume of calls and met demands of busy and productive group.
Personal Banker
Wells Fargo, Customer Service Call Center
Hybird
09.2013 - 09.2016
- Helped customers complete online banking services and assisted with user access problems such as forgotten passwords.
- Completed transactions for customers and capitalized on opportunities to cross-sell products and services.
- Maintained friendly and professional customer interactions.
- Handled various accounting transactions.
- Established rapport with new clients to increase satisfaction and loyalty.
- Calculated fees due, interest and change for customer transactions.
- Carried out day-day-day duties accurately and efficiently.
- Performed duties in accordance with applicable standards, policies and regulatory guidelines to promote safe working environment.
- Resolved concerns with products or services to help with retention and drive sales.
- Documented and detailed calls and complaints using call center's CRM database.
- Helped large volume of customers every day with positive attitude and focus on customer satisfaction.
Credit Bureau Specialist
Ranstad Staffing
Homewood Al
09.2011 - 09.2013
- Collected data and performed trend and variance analysis to determine whether information on credit is correct.
- Advised accounts and assisted through qualification processes.
- Assisted with reconciliations.
- Monitored accounts for signs of fraud and non-payment issues.
- Updated credit bureau records with accurate, current information.
- Removed inaccurate information from credit report.
- Utilized specialized software to capture and process data.
- Extensive communication completed by email only.
- Working knowledge of FCRA requirements and CDIA Metro2 guidelines
Education
Diploma -
Fairfield High School
Fairfield, AL05.2011
Skills
- Payroll
- Leadership
- Verbal and Written Communication
- HR Compliance
- Background Check Processes
- Administrative Support
- Problem-Solving Ability
- Customer Service Optimization
- Error Identification
- Data Integrity
- Information Verification
- Good Telephone Etiquette
- Clerical Support
- Problem-Solving
- Teamwork and Collaboration
- Email Correspondence
- Online Chat
- Client Rapport-Building
- Claims analysis
- Claims review
- Critical Thinking
- System Analysis
- Workflow Analysis
Certification
Customer Service (10+ years)
Management (7 years)
Clerical (5 years)
Administrative Assistant (4 years)
Receptionist (4 years)
Additional Information
- Willing to relocate to:, Authorized to work in the US for any employer
Timeline
Claims Analyst
Blue Cross Blue Shield Of Alabama
05.2023 - Current
Benefits Verification Specialist
Talent Bridge/ Lash Group
10.2022 - 05.2023
Unemployment Claims Specialist
Adecco
11.2019 - 05.2021
Operations Manager
Anchor Leg Solutions LLC
11.2018 - 07.2021
Store Manager
CREDIT CENTRAL
12.2016 - 10.2018
Personal Banker
Wells Fargo, Customer Service Call Center
09.2013 - 09.2016
Credit Bureau Specialist
Ranstad Staffing
09.2011 - 09.2013
Diploma -
Fairfield High School