Darolyn Gray
Mesquite,United States
Summary
Dynamic Benefits Specialist with a strong background in insurance at Blue Cross Blue Shield of Texas. Expert in claims processing and documentation research, delivering exceptional customer service and resolving complex billing inquiries. Proven attention to detail and ability to communicate effectively, ensuring client satisfaction and efficient claims resolution.
Overview
12
12
years of professional experience
Work History
Benefits Specialist
Blue Cross Blue Shield of Texas
Richardson, TX
10.2022 - Current
- Assisted in resolving claim issues related to billing and reimbursement inquiries.
- Interpreted Explanation of Benefits statements from various insurers and communicated relevant information with other departments as needed.
- Responded promptly to customer inquiries regarding their benefits and eligibility status.
- Assisted customers with information regarding benefits and claims.
- Assisted with customer inquiries, complaints, and requests for information regarding insurance policies.
- Responded promptly to emails and phone calls from customers seeking assistance.
Claims Representative
NTT Data (BCBS OF MICHIGAN)
Plano, TX
06.2019 - 10.2022
- Provided quality customer service to assigned, insured and claimants throughout claims process to deliver timely service to customers.
- Verified details with policyholders and requested additional information.
- Delivered quality customer service to assigned, insured and claimants throughout entire claims lifecycle to promote service times.
- Accurately processed large volume of medical claims every shift.
- Reviewed claims for accuracy before submitting for billing.
- Called insurance companies to ascertain pertinent information regarding policies and payment benefits for patients.
Credit Balance Specialist
Diversified HealthCare Services
Richardson, TX
11.2016 - 05.2019
- Reviewed company portfolio of clients to flag delinquent accounts and identify high-performing accounts to target for future advertising and promotions.
- Double-checked account and application information provided by clients to assist in making accurate credit decisions.
- Reviewed accounts for signs of fraud and non-payment issues.
- Entered credit slips and return requests to issue authorizations and process returns documentation.
- Contacted customers to notify of delinquent payments and resolve.
- Kept detailed reports of client and account data, consistently updating database with latest information.
Claims Assistant
Sedgwick Claims Management
Plano, TX
02.2013 - 10.2016
- Opened, sorted and monitored claims.
- Provided quality customer service to assigned, insured and claimants throughout claims process to deliver timely service to customers.
- Verified details with policyholders and requested additional information.
- Reviewed documentation and accounts to gain full picture.
- Complied with confidentiality regulations in handling customer information.
- Called insurance companies to ascertain pertinent information regarding policies and payment benefits for patients.
Education
Naaman Forest High School
Garland, TX06.2009
Prairie View A&M University
Prairie View, TXSkills
- Policy knowledge
- Settlement agreements
- Documentation research
- Background in insurance
- Medical terminology
- Claims processing
- Attention to detail
- Data entry
- Insurance verification
Education and Training
other
Timeline
Benefits Specialist
Blue Cross Blue Shield of Texas
10.2022 - Current
Claims Representative
NTT Data (BCBS OF MICHIGAN)
06.2019 - 10.2022
Credit Balance Specialist
Diversified HealthCare Services
11.2016 - 05.2019
Claims Assistant
Sedgwick Claims Management
02.2013 - 10.2016
Naaman Forest High School
Prairie View A&M University
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