Devin Watson-Smith
El Mirage,AZ
Summary
Motivated and detail-oriented High Dollar Claims Adjuster with over 4 years of experience in health insurance claims processing, data entry, and payment management. Proven expertise in handling high-dollar claims, negotiating settlements, crafting Explanation of Benefits (EOB) reports, and managing complex provider and member interactions. Highly skilled in contract negotiations, employee services, and leveraging technology to optimize workflow. Adept at maintaining accuracy under pressure while delivering high-quality customer service and ensuring compliance with industry standards. Seeking to bring my expertise to a dynamic and client-focused role.
Overview
10
10
years of professional experience
1
1
Certification
Work History
High Dollar Claims Adjuster and Contracting Specialist
Redirect Health
01.2024 - Current
- Manage and adjust high-dollar health insurance claims, ensuring accurate processing and adherence to company policies
- Negotiate backend agreements, including single case agreements and settlement proposals, to resolve complex claims issues
- Develop and deliver comprehensive Explanation of Benefits (EOB) reports for members, providing clear explanations of claim resolutions and member responsibilities
- Collaborate with providers to resolve claims appeals, clarifying payment determinations and addressing inquiries
- Maintain a high level of accuracy and attention to detail while handling claims volumes in a fast-paced environment
High Dollar Claims Examiner
Redirect Health
01.2023 - 12.2023
- Examined and processed high-dollar health insurance claims, ensuring compliance with all relevant policies and regulations
- Assisted in identifying discrepancies in claims and worked with the appropriate departments to correct errors or resolve issues
- Provided assistance to team members by sharing knowledge and insights on complex claims situations
Claims Analyst
Redirect Health
01.2022 - 12.2022
- Analyzed and processed a variety of health insurance claims, ensuring timely and accurate resolution
- Worked closely with members and providers to resolve discrepancies and ensure clear communication on claim statuses
- Monitored claim status and worked to expedite delays while maintaining high levels of customer satisfaction
Payment Specialist
Redirect Health
01.2021 - 12.2021
- Ensured the accurate processing of health insurance payments, facilitating claims resolution through detailed analysis
- Reviewed and adjusted payment discrepancies to ensure compliance with policy guidelines and contractual obligations
- Collaborated with team members to resolve payment-related issues and ensure timely processing
Data Entry Claims Specialist
Redirect Health
01.2021 - 12.2021
- Processed and entered claims data accurately into the system, ensuring quick and efficient claims resolution
- Verified information on claims submissions, identifying discrepancies and working with other departments to rectify errors
Lead Employee Self Service
Safeway Albertsons Corporate
01.2020 - 12.2020
- Led a team responsible for managing employee self-service inquiries and assisting with payroll-related issues
- Provided training and support to new team members, ensuring high-quality service and problem resolution
- Maintained a high level of professionalism while handling sensitive employee data and issues
Employee Self Service
Safeway Albertsons Corporate
01.2018 - 12.2019
- Assisted employees with self-service inquiries, including payroll, benefits, and personal information updates
- Resolved issues efficiently while maintaining a high level of confidentiality and adherence to company policies
Collector
PayPal Credit
01.2017 - 12.2017
- Managed collections for delinquent accounts, negotiating repayment plans and resolving payment discrepancies
- Provided high-quality customer service while maintaining a professional demeanor in all interactions
Collector
Gateway One Lending and Finance
01.2016 - 12.2016
- Assisted in managing accounts receivable, collecting outstanding balances, and negotiating payment terms
- Ensured all collection activities were compliant with applicable regulations and company standards
Crew Member
Trader Joe's
01.2015 - 12.2016
- Provided exceptional customer service in a fast-paced retail environment
- Assisted with inventory management, stocking shelves, and maintaining store cleanliness
- Developed strong communication and teamwork skills, working with colleagues to enhance customer satisfaction
Education
High School Diploma - General
Willow Canyon
Surprise, AZ05.2012
Skills
- Claims Adjusting & Processing
- High-Dollar Claims Management
- Contract Negotiation
- Explanation of Benefits (EOB) Reporting
- Data Entry & Claims Review
- Customer & Provider Outreach
- Dispute Resolution
- Problem-Solving & Critical Thinking
- Attention to Detail
- Deadline-Driven & Organized
- Compliance & Industry Knowledge
Certification
- [Certification Name]
Timeline
High Dollar Claims Adjuster and Contracting Specialist
Redirect Health
01.2024 - Current
High Dollar Claims Examiner
Redirect Health
01.2023 - 12.2023
Claims Analyst
Redirect Health
01.2022 - 12.2022
Payment Specialist
Redirect Health
01.2021 - 12.2021
Data Entry Claims Specialist
Redirect Health
01.2021 - 12.2021
Lead Employee Self Service
Safeway Albertsons Corporate
01.2020 - 12.2020
Employee Self Service
Safeway Albertsons Corporate
01.2018 - 12.2019
Collector
PayPal Credit
01.2017 - 12.2017
Collector
Gateway One Lending and Finance
01.2016 - 12.2016
Crew Member
Trader Joe's
01.2015 - 12.2016
High School Diploma - General
Willow Canyon
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