Deon Richardson
Claims Adjuster
Houston,TX
Summary
Resourceful Claims Adjuster known for high productivity and efficiency in task completion. I specialize in claims investigation, health insurance knowledge, and HIPPA laws. I can manage multiple cases simultaneously. Excel at communication, problem-solving, and decision-making, ensuring fairness and satisfaction in claim resolutions.
Overview
6
6
years of professional experience
Work History
Claims Adjuster
International Benefits Administration
REMOTE, N/A
12.2022 - Current
- Manage caseload effectively, prioritizing urgent or high-value claims for prompt attention.
- Determine and authorize appropriate payment for claims.
- Maintain precise data entry for provider information and service records.
- Evaluate insurance policies to identify coverage limits, exclusions, and constraints.
- Reviewed claims for accuracy before submitting them for billing.
- Stays current on HIPAA regulations, benefits claims processing, medical terminology, and other procedures.
- Utilize ICD-10, CPT, and HCPCS coding systems for precise claim processing.
Provider Services Representative
WPS Health Solutions
REMOTE, N/A
06.2022 - 12.2022
- Guided providers on claim matters.
- Promoted high customer satisfaction by resolving problems with knowledgeable and friendly service.
- Worked with adjusters and underwriters to address challenging claim problems.
- Examined database reports to detect patterns in denials.
- Verified claim data correctness in preparation for processing.
- Addressed provider inquiries to provide information and explanations on coverage and terms, expediting claims.
- Engaged with providers for claim decision explanations and inquiry responses.
- Adhered to HIPAA privacy standards when handling confidential patient information.
Logistics Specialist
VLC Distribution
Houston , TX
04.2021 - 06.2022
- Managed inventory levels to ensure optimal stock at all times, reducing shortages and overages.
- Resolves out-of-stock situations, discovers and analyzes discrepancies in inventory data, recommends improvements, and helps implement changes to the inventory control systems.
- Utilized software programs to track shipments from origin to destination.
- Maintains accurate daily records of goods received and transactions into and out of the stockroom.
- Identified areas for improvement within the logistics department and recommended solutions.
- Loaded, unloaded, moved and sorted materials to keep items flowing to correct locations.
Customer Service Representative
Blue Cross NC
Winston-Salem, NC
08.2019 - 04.2021
- Provided excellent customer service to resolve customer complaints promptly.
- Increased customer satisfaction ratings by effectively answering questions, suggesting effective solutions, and resolving issues quickly.
- Answered incoming calls and emails, providing frontline customer support or assistance with product and service transactions.
- Monitored clients' insurance coverages to ensure changing needs were met.
- Fielded inbound calls from customers inquiring about alternative insurance options to generate sales opportunities.
- Advised clients on health insurance options, including coverage and cost comparisons.
Logistics Specialist
Vertical Supply Group
Greensboro, NC
08.2018 - 07.2019
- Receive and fulfill orders in a timely, efficient manner.
- Track all orders via delivery software.
- Note inventory levels and alert supervisors to potential issues.
- Tracking inventory maintenance.
- Controlling flows of equipment and supplies.
- Reporting to management and advising on process improvements.
- Coordinating and directing multiple teams.
- Developing loss mitigation processes and protocols.
Education
MBA - Public Administration
Strayer University
Houston, TX12-2024
Bachelor of Science - Business Administration
Belhaven University
Jackson, MS05-2018
High School Diploma -
Mclaurin High School
Florence, MS05-2013
Skills
- Advanced computer skills
- Customer service
- Type 50 words per minute
- strong sense of time
- attentive
- problem-solving
- Health insurance plan knowledge
- Insurance billing
Timeline
Claims Adjuster
International Benefits Administration
12.2022 - Current
Provider Services Representative
WPS Health Solutions
06.2022 - 12.2022
Logistics Specialist
VLC Distribution
04.2021 - 06.2022
Customer Service Representative
Blue Cross NC
08.2019 - 04.2021
Logistics Specialist
Vertical Supply Group
08.2018 - 07.2019
MBA - Public Administration
Strayer University
Bachelor of Science - Business Administration
Belhaven University
High School Diploma -
Mclaurin High School
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