Destiny Parker
Louisville,KY
Summary
Claims adjuster focused on efficient resolution, insurance compliance, and clear communication. Analyze claims data to support accurate decisions and strengthen process performance. Improve operational efficiency and client satisfaction through workflow enhancements. Results-driven Claims Adjuster with strong skills in claims resolution strategies and insurance negotiation. Committed to compliance and enhancing client satisfaction through effective communication and organizational multitasking. Detail-oriented professional specializing in claims evaluation and compliance. Skilled in analyzing claim data to identify trends and improve processing accuracy. Aiming to leverage expertise to enhance operational efficiency and client understanding in the insurance sector.
Overview
5
5
years of professional experience
Work History
Claims Adjuster
Molina Healthcare
Louisville, Kentucky
04.2023 - Current
- - Evaluated insurance claims for accuracy and regulatory compliance.
- - Analyzed claim data to identify trends and issues, supporting informed decision-making.
- - Reviewed claim records to identify trends and issues, enhancing accuracy of claims processing.
- - Explained claim decisions to policyholders and stakeholders, improving understanding and satisfaction.
- - Partnered with healthcare providers to gather necessary documentation.
- - Worked with team members across multiple departments to identify process improvement opportunities.
- - Followed departmental guidelines and maintained compliance with applicable state laws.
- - Attended claim committee meetings to contribute insights and discuss case progress. to discuss current cases and issues.
SAF Caseworker
Red Cross
Louisville, ky
02.2022 - 02.2023
- Provided crisis intervention and emotional support to clients in distress.
- Conducted needs assessments to determine client eligibility for assistance programs.
- Assisted clients in accessing resources and services for disaster relief.
- Educated clients on available resources and self-help strategies for recovery.
- Coordinated with community partners to facilitate outreach and support initiatives.
- Maintained accurate case records and documentation for compliance purposes.
- Followed strict policies and procedures to maintain client confidentiality and keep data private.
- Participated in training sessions to improve service delivery and client engagement.
Education
Associate of Arts - Billing And Coding/Reimbursement Specialist.
JCTC
Louisville05-2027
Skills
- Claims resolution strategies
- Insurance negotiation skills
- Compliance with regulations
- CMS claims processing guidelines
- Client assessment and workflow optimization
- Organizational multitasking
- Communication proficiency
- Salesforce, QNXT, Cotivity, and Availity expertise
- Knowledge of Genesys and Facets systems
- Fee schedule oversight
- Results-driven
- Clear communication
- Results-driven
Timeline
Claims Adjuster
Molina Healthcare
04.2023 - Current
SAF Caseworker
Red Cross
02.2022 - 02.2023
Associate of Arts - Billing And Coding/Reimbursement Specialist.
JCTC