Dezire Scott
Grand Prairie,TX
Summary
Dynamic Claims Representative with a proven track record at TelHealth, adept at claims processing and investigation. Expert in data analysis and documentation review, enhancing claim resolution efficiency. Recognized for exceptional customer service and time management skills, ensuring compliance and accuracy in insurance claims while maintaining patient confidentiality.
Demonstrates strong analytical, communication, and teamwork skills, with proven ability to quickly adapt to new environments. Eager to contribute to team success and further develop professional skills. Brings positive attitude and commitment to continuous learning and growth.
Overview
7
7
years of professional experience
Work History
Claims Representative
TelHealth
12.2024 - 11.2025
- Collaborated with healthcare providers to clarify claim details and resolve discrepancies.
- Followed up with customers on unresolved issues.
- Processed and evaluated insurance claims, ensuring compliance with policy guidelines.
- Developed in-depth understanding of insurance policies and procedures.
- Reduced claim resolution times with thorough documentation and timely follow-up.
- Processed and recorded new policies and claims.
- Notified insurance agents and accounting departments of policy cancellations and changes.
- Maintained confidentiality of patient finances, records, and health statuses.
- Modified, updated and processed existing policies.
Enrollment Specialist
Humana
10.2022 - 12.2024
- Facilitated enrollment processes to ensure timely and accurate member onboarding.
- Analyzed member feedback to identify trends and implement enhancements in enrollment practices.
- Process enrollment applications for healthcare benefits
- Fix errors on applications that were submitted
- Assisted with incomplete enrollment applications
- Determine eligibility for benefits
- Use multiple systems to review applications and correct errors
- Send out letters for missing information on enrollment applications
Insurance Verification Specialist
McKesson
01.2020 - 08.2022
- Verified patient insurance eligibility and coverage details to ensure accurate billing processes.
- Collaborated with healthcare providers to resolve insurance discrepancies and enhance claim approval rates.
- Utilized electronic health record systems to maintain up-to-date patient information for verification purposes.
- Analyzed insurance policies and procedures to streamline verification workflows and improve efficiency.
- Conducted regular audits of verification records to uphold accuracy and compliance with industry standards.
- Ensured compliance with HIPAA regulations while managing sensitive patient information during the verification process.
- Collaborated with team members to resolve discrepancies in insurance verification, ensuring proper billing practices.
- Enhanced claim processing efficiency by verifying insurance coverage and obtaining pre-authorizations for procedures.
- Expedited patient registration process by efficiently validating eligibility for various insurance plans.
Patient Care Associate
LYP Health
09.2018 - 07.2020
- Collaborated with healthcare professionals to enhance patient experience and outcomes.
- Assisted patients with appointment scheduling and insurance verification.
- Provided exceptional customer service by addressing patient inquiries and concerns.
- Coordinated communication between patients and healthcare providers to ensure seamless care.
- Maintained accurate patient records using electronic health record (EHR) systems.
- Maintained confidentiality of patient data and condition to safeguard health information.
- Efficiently managed high volumes of phone calls, messages, and inquiries from patients or other healthcare providers, ensuring prompt responses and resolutions.
- Coordinated patient referrals to specialists or external facilities when necessary for further treatment or evaluation.
- Handled prescription refill requests.
- Answered incoming calls, scheduled appointments and filed medical records.
Education
Associate of Science - Business Administration And Management
Tarrant County College
Fort Worth, TXHigh School Diploma -
Justin F Kimball High Scool
05-2018
Skills
- Microsoft office
- Insurance claims review
- Claims investigation
- Time management
- Data analysis
- Documentation review
- Claims processing
- Customer service
Timeline
Claims Representative
TelHealth
12.2024 - 11.2025
Enrollment Specialist
Humana
10.2022 - 12.2024
Insurance Verification Specialist
McKesson
01.2020 - 08.2022
Patient Care Associate
LYP Health
09.2018 - 07.2020
Associate of Science - Business Administration And Management
Tarrant County College
High School Diploma -
Justin F Kimball High Scool