DONAVEN JONES
Kansas City,KS
Overview
4
4
years of professional experience
Work History
Fraud Investigator
Charter Communications Inc.
09.2024 - Current
- Performed detailed background checks on individuals suspected of fraudulent activity to gather critical information needed for successful investigations.
- Provided exceptional customer service to clients affected by fraudulent activities, addressing their concerns while maintaining compliance with regulatory guidelines.
- Maintained a high level of confidentiality when handling sensitive information, protecting both company reputation and client privacy.
- Conducted prompt and thorough investigations on referred files.
- Monitored account activity in real-time for early detection and swift resolution of potential issues before they escalated into significant losses for the organization.
- Enhanced internal communication by providing regular updates on current fraud trends and emerging threats.
Medicare Member Services Representative
UCare
07.2023 - 09.2024
- Complied with HIPAA guidelines and regulations for confidential patient data
- Educated clients about Medicare/Medicaid health insurance coverage options, benefits and costs
- Maintained strong knowledge of basic medical terminology to better understand services and reverified insurance coverage by telephone and online to guarantee proper reimbursement of benefits and estimate patients' financial responsibilities
- Answered 50+ inbound calls daily from existing and future policyholders to answer inquiries and discuss insurance options
- Assisted clients with filing and tracking health insurance claims to facilitate swift settlements
- Worked with sales team to collaboratively reach targets, consistently meeting or exceeding personal quotas
- Actively listened to customers, handled concerns quickly and escalated major issues to supervisor
- Addressed customer account discrepancies and concerns
- Placed outbound customer service or customer satisfaction calls to follow up on issues
Clinical Support Specialist
LMH Health
02.2021 - 07.2023
- Complied with HIPAA guidelines and regulations for confidential patient data
- Maintained strong knowledge of basic medical terminology to better understand services and procedures
- Managed office bookkeeping with insurance billing and patient payments
- Generated reports to track insurance verifications and claim progress
- Assured timely verification of insurance benefits prior to patient procedures or appointments
- Contacted insurance carriers to discuss policies and individual patient benefits
- Assisted patients with understanding personalized insurance coverage and benefits
- Scheduled patient appointments in respective doctors' calendars and followed up with reminder phone calls
Education
B.G.S - Communications
University of Kansas
Lawrence, KS05-2026
Minor - Journalism
University of Kansas
11.2023
High School Diploma -
Wyandotte High School
05.2020
Timeline
Fraud Investigator
Charter Communications Inc.
09.2024 - Current
Medicare Member Services Representative
UCare
07.2023 - 09.2024
Clinical Support Specialist
LMH Health
02.2021 - 07.2023
High School Diploma -
Wyandotte High School
B.G.S - Communications
University of Kansas
Minor - Journalism
University of Kansas
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