Diamond Bailey
Summary
Pragmatic insurance services Specialist touting eight years of expertise in benefits explanation and coverage tracking. A team player with a vast knowledge of medical terms and billing ethics. Also working with all types of personalities effectively. Offering dynamic organizational skills and attention to detail. Created innovative ways to enhance training programs to accelerate the learning curve and structure teams to accomplish specific objectives. Detail-oriented team player with strong organizational skills and the ability to handle multiple projects simultaneously with a high degree of accuracy. Successfully navigated fluctuating conditions and unknowns. Tailoring service protocols to the individual beneficiary to achieve breakthrough results. Customer and quality key point indicators met or exceeded.
Overview
4
4
years of professional experience
Work History
Claims Processing Specialist
Maximus with California State EDD
11.2020 - 02.2023
- Processed and reviewed unemployment insurance claims, Deciphered if the individual claimant was eligible for specific UI programs such as the MUEC program connected to the Earned Income Tax Credit with the IRS
- Additional Job duties in this position include but were not limited to assisting claimants with verifying their identity as a tier one level representative
- As a tier one representative, analyze various documents closely to ensure the specific information provided meets the department's standard, so the case can be elevated to the next level
- Impact: Implemented the company motto of “Helping the government serve the people” by delivering the best customer and client service, whilst acquiring knowledge of different internal programs of the EDD and translating that into indispensable job and career skills.
- Evaluated and settled complex insurance claims in strict timeframes.
- Worked with claims adjusters and examiners to expedite processing in alignment with procedures.
- Complied with regulations and guidelines related to claims processing to maintain quality and adherence to standards.
- Assisted in the onboarding of new claims processors to familiarize them with company procedures, policies, and processes.
- Managed workload and priorities to meet claims processing meet deadlines.
- Affirmed or denied eligibility fairly based on thorough investigations.
- Collaborated with claims department and industry anti-fraud organizations to resolve claims.
- Utilized excellent analytical and problem-solving skills to quickly and accurately assess insurance claims.
- Reviewed applications and supporting documents to verify claims eligibility and accuracy.
- Followed up with customers on unresolved issues.
- Established positive and trusting relationships with injured clients, administering efficient customer service and processing claims quickly.
Beneficiary Service Representative
Medi-cal
02.2020 - 10.2020
- Handles inbound calls from the existing members and general public that have questions or issues with the California state Medicaid program.
- Provided information to members and or prospective members with overall advice on how to resolve complex issues regarding their Medical care and billing issues
- Proper documentation of the calls in CRM(customer relations management) was an important part of daily tasks
- Utilizing and navigating the software was imperative
- In addition, Critical thinking was also a crucial component in dealing with and interpreting someone's protected health information
- It was important we effectively and professionally solve problems with integrity and preciseness to meet Medicaid's service guidelines
- In this role, it was also imperative to work and collaborate with other team members to not only ensure the appropriate action was taken in concern of the beneficiary's health and medical care
- Proven ability to learn quickly and adapt to new situations.
- Worked well in a team setting, providing support and guidance.
- Improved and learned the foundation of customer service, taking the caller's satisfaction and converting it into our own
- Secondly contributed to the learning experience of the call center team with knowledge and encouragement for a productive, welcoming atmosphere.
- Helped a large volume of customers every day with a positive attitude and focus on customer satisfaction.
- Responded to customer calls and emails to answer questions about products and services.
- Delivered exceptional customer service on benefits issues through active listening, patience, and prompt response with resolutions or actionable next steps.
- Self-motivated, with a strong sense of personal responsibility.
Front Desk Receptionist
Images II Barbershop and Salon
03.2019 - 12.2019
- Managed the salons incoming volume, communicated with the salon's owner and shift manager to ensure expectations were met
- Assisted Licensed Cosmetologist with preparing their stations, in addition to schedule follow up appointments with guests to guarantee a consistent client base
- Was well versed in Vita Livest and their customer relationship management motive
- Impact: Increased the salons customer volume by 30 % making sure the customers needs and expectations were properly met.
- Scheduled, coordinated and confirmed appointments and meetings.
- Collected room deposits, fees, and payments.
- Completed data entry and filing to keep records updated for easy retrieval.
- Handled incoming and outgoing package deliveries, working with vendors to complete special requests and track missing packages.
Education
Associate - General studies
American River College
Sacramento, CAAssociate of Applied Science - Medical Billing And Coding
Carrington College California - Sacramento
Sacramento, CA05.2024
Skills
- Solid Customer service qualities, strong analytical and decisive problem-solving ability
- Excellent people and interpersonal development skills to build effective relationships through training and team
- Microsoft Office (Excel, Word, Outlook)
- Customer Relationship Management
- Medical Terminology
- Claims Processing
- ICD-9 codes
- Type 50wpm or 12,500 kph
- Salesforce
- Adobe Acrobat
Accomplishments
- The Miss America Foundation (501)(c)(3)- 2nd runner state titleholder up to Miss America's Outstanding Teen 2013, won a $2,500 college scholarship. In addition to numerous hours of community service and immeasurable character-building to whereas still presently an active member in the organization.
- Achieved maximum efficiency by introducing Microsoft Excel for charting claims to meet individual and team quotas for the utmost productivity and success
- Documented and resolved the representative-to-beneficiary empathy gap which led to better communication and care within the call center operation.
Timeline
Claims Processing Specialist
Maximus with California State EDD
11.2020 - 02.2023
Beneficiary Service Representative
Medi-cal
02.2020 - 10.2020
Front Desk Receptionist
Images II Barbershop and Salon
03.2019 - 12.2019
Associate - General studies
American River College
Associate of Applied Science - Medical Billing And Coding
Carrington College California - Sacramento
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