Edwina Bounds
Indianola,MS
Summary
Experienced Insurance Claims Specialist with a strong background at State Farm. Skilled in claims analysis and policy interpretation. Thrived in a fast-paced environment, consistently improving customer satisfaction through analytical thinking and effective teamwork. Demonstrated expertise in data entry and proven ability to collaborate, resulting in streamlined claim processing and enhanced patient care outcomes.
Insurance professional with comprehensive experience in claims management, adept at assessing, processing, and resolving claims efficiently. Proven skills in investigation, analysis, and negotiation, ensuring fair outcomes and policy compliance. Strong focus on team collaboration and adaptability, delivering results through effective communication and problem-solving. Reliable and flexible, meeting changing needs and maintaining high standards in all tasks.
Overview
9
9
years of professional experience
Work History
Insurance Claims Specialist
State Farm
09.2022 - 10.2024
- Evaluated and settled complex insurance claims in strict timeframes.
- Followed up with customers on unresolved issues.
- Worked with claims adjusters and examiners to expedite processing in alignment with procedures.
- Demonstrated mastery of basic medical terms to enhance service and procedure insights.
- Managed payment postings accurately to ensure account records remained up-to-date.
- Made contact with insurance carriers to discuss policies and individual patient benefits.
- Checked documentation for accuracy and validity on updated systems.
- Reviewed and finalized claim forms ensuring all required information was included.
Certified Clinical Medical Assistant
Leland Medical
08.2016 - 02.2022
- Called and faxed pharmacies to submit prescriptions and refills.
- Directed patients to exam rooms, fielded questions, and prepared for physician examinations.
- Collected and documented patient medical information such as blood pressure and weight.
- Taught patients about medications, procedures, and care plan instructions.
- Sanitized, restocked, and organized exam rooms and medical equipment.
- Assisted with routine checks and diagnostic testing by collecting and processing specimens.
- Enhanced patient outcomes by providing knowledgeable education on procedures, medications, and other physician instructions.
- Obtained client medical history, medication information, symptoms, and allergies.
- Assisted physicians with minor surgeries, including preparing operating room and sterilizing instruments.
- Answered telephone calls to offer office information, answer questions, and direct calls to staff.
Mental Health Technician
Allegience Hospital /Inspiration
08.2015 - 07.2016
- Performed scheduled patient safety checks and documented results to establish patients' well-being.
- Identified behaviors that necessitated intervention and obtained assistance from qualified personnel to complete intervention.
- Observed patient behaviors and mental status and notified RN of unusual or potentially dangerous occurrences.
- Assisted with patient restraint and seclusion scenarios to create safe environment for patient and medical personnel.
- Engaged with colleagues in treatment team meetings to promote positive patient treatment outcomes.
- Supported patients needing medical care to relieve patient anxiety and promote positive outcomes.
Education
Health Care Adminstration -
American International College
Springfield, MA05-2016
Associate of Arts -
Mississippi Delta Community College
Moorhead, MS05.2009
Skills
- Claims Investigation
- Claims analysis
- Policy Interpretation
- Data Entry
- Teamwork and Collaboration
- Analytical Thinking
- Claims investigation
- HIPAA compliance
- De-escalation techniques
- Immunization administration
Accomplishments
- Dean’s List academic achievement
- Customer satisfaction
Languages
English
Full Professional
Timeline
Insurance Claims Specialist
State Farm
09.2022 - 10.2024
Certified Clinical Medical Assistant
Leland Medical
08.2016 - 02.2022
Mental Health Technician
Allegience Hospital /Inspiration
08.2015 - 07.2016
Health Care Adminstration -
American International College
Associate of Arts -
Mississippi Delta Community College