Dawn Moore
Houston,TX
Summary
Insurance Customer Service and Claims professional with 10+ years of experience in coverage verification, policy review, claims processing. Skilled at investigating billing discrepancies, documenting case notes, and supporting timely issue resolution with carriers, providers, customers and internal teams. Strong background in HIPAA-compliant member support.
Overview
11
11
years of professional experience
Work History
Insurance Customer Service Representative
Premera Blue Cross, BCBS Association
05.2025 - 10.2026
- Resolved complex benefit inquiries, clarifying plan coverage, eligibility, and claim status.
- Coordinated issue resolution with carriers, providers, and internal teams.
- Investigated billing and claim discrepancies, identifying root causes and corrective actions.
- Handled sensitive customer information with discretion, adhering to strict data privacy regulations at all times.
- Assisted customers with completing insurance documents to avoid missed information.
- Enhanced customer satisfaction by addressing and resolving insurance-related inquiries and concerns.
Insurance Customer Service Representative
Empyrean Benefits Solutions
08.2021 - 04.2025
- Processed enrollments, terminations, and dependent changes with strict accuracy.
- Interpreted insurance policies and explained benefits, copays, deductibles, and claim procedures.
- Maintained HIPAA compliance while handling sensitive member information and confidential records.
- Managed high call volume while maintaining professionalism, empathy, and attention to detail in each interaction.
- Documented member interactions and case notes in CRM systems for seamless follow-up.
Medical Billing Specialist
Alliance Health Sciences (American Pathology)
07.2015 - 03.2021
- Reconciled insurance denials, corrected claim errors, and resubmitted appeals to support timely reimbursement.
- Processed pathology claims, verified coding accuracy, and resolved billing discrepancies across patient accounts.
- Reviewed CPT, ICD-10, and modifier usage to ensure compliant charge capture for laboratory services.
- Coordinated with payers, patients, and internal teams to resolve coverage questions and billing issues.
- Precisely evaluated and verified benefits and eligibility.
- Verified insurance of patients to determine eligibility.
- Posted payments and collections on a regular basis.
Education
High School Diploma -
Kappa High School
RichmondSkills
- Claims processing
- Denied claims analysis
- Insurance coverage verification
- Insurance terminology
- Client guidance
- Policy review
- Customer service
- Complaint handling
- Attention to detail
- Claims adjudication
- Coverage verification
- CRM documentation
Timeline
Insurance Customer Service Representative
Premera Blue Cross, BCBS Association
05.2025 - 10.2026
Insurance Customer Service Representative
Empyrean Benefits Solutions
08.2021 - 04.2025
Medical Billing Specialist
Alliance Health Sciences (American Pathology)
07.2015 - 03.2021
High School Diploma -
Kappa High School