Summary
Overview
Work History
Education
Skills
Timeline
Generic

Erica Jones-Davidson

Columbus,Georgia

Summary

Diligent Claims Processor versed in insurance processes and claims procedures. Offers great attention to detail and time management abilities to successfully handle large volume of claims. Highly accurate and thorough with focus on completing error-free work in line with processing guidelines. Highly trained professional with a background in verifying insurance benefits and creating appropriate patient documentation. An established Insurance Verification Specialist known for handling various office tasks with undeniable ease.

Overview

13
13
years of professional experience

Work History

Claims Processor

Anthem Inc.
10.2022 - Current
  • Maintained knowledge of benefits claim processing, claims principles, medical terminology, and procedures and HIPAA regulations.
  • Verified patient insurance coverage and benefits for medical claims.
  • Managed large volume of medical claims on daily basis.
  • Paid or denied medical claims based upon established claims processing criteria.
  • Monitored and updated claims status in claims processing system.
  • Identified and resolved discrepancies between patient information and claims data.
  • Used administrative guidelines as resource or to answer questions when processing medical claims.
  • Assessed medical claims for compliance with regulations and corrected discrepancies.
  • Reviewed provider coding information to report services and verify correctness.
  • Maintained strong knowledge of basic medical terminology to better understand services and procedures.
  • Calculate adjustments.
  • Determined appropriateness of payers to protect organization and minimize risk.
  • Trained new employees on claims processing procedures, contributing to a well-prepared workforce.
  • Maintained detailed records of all processed claims for easy retrieval during audits or disputes.
  • Maintained strict confidentiality when dealing with sensitive information about patients'' medical histories or personal details.
  • Participated in various professional development opportunities to stay current on industry regulations, best practices, and emerging technologies relevant to claim processing activities.
  • Resubmitted claims after editing or denial to achieve financial targets and reduce outstanding debt.

Customer Service Representative

Anthem, Inc.
01.2019 - Current
  • Take ownership and resolve issues with care and concern with each member
  • Act as an advocate for consumers by providing support and guidance of their anticipated needs, personal options and decisions
  • Show initiative and resourcefulness in solving problems and meeting consumer needs
  • Develop relationships with other business units and service partners whose assistance, cooperation and support may be needed
  • Demonstrate empathy, exceptional written and verbal communication skills, and the ability to properly tailor assistance to a consumer's level of experience and knowledge
  • Answering multiple calls and emails from members in regards to their insurance policies
  • Managing members’ claims, insurance contracts and other insurance benefits, updating and forwarding inquiries to different departments
  • In this position, I am very experienced when it comes to HIPPA and PHI
  • Keeping all documentation and protecting every members information with confidentiality on ever phone call I receive.
  • Handled customer inquiries and suggestions courteously and professionally.
  • Actively listened to customers, handled concerns quickly and escalated major issues to supervisor.
  • Maintained customer satisfaction with forward-thinking strategies focused on addressing customer needs and resolving concerns.
  • Clarified customer issues and determined root cause of problems to resolve product or service complaints.
  • Enhanced customer satisfaction by promptly addressing concerns and providing accurate information.
  • Assisted customers in navigating company website and placing online orders, improving overall user experience.
  • Developed strong product knowledge to provide informed recommendations based on individual customer needs.
  • Maintained detailed records of customer interactions, ensuring proper follow-up and resolution of issues.
  • Managed high-stress situations effectively, maintaining professionalism under pressure while resolving disputes or conflicts.
  • Handled escalated calls efficiently, finding satisfactory resolutions for both customers and the company alike.

Escalations Agent (Floor Supervisor)

Total Systems
01.2017 - 11.2018
  • Serves customers by determining requirements; answering inquiries; resolving problems; fulfilling requests
  • Processing credit card applications for customer, processing credit card payments, closing credit card accounts and monitoring credit card accounts for fraud alerts
  • Take over Calls when the customer wants to speak with a supervisor.
  • Delivered exceptional customer service to every customer by leveraging extensive knowledge of products and services and creating welcoming, positive experiences.
  • Investigated and resolved customer inquiries and complaints quickly.
  • Accomplished multiple tasks within established timeframes.
  • Expanded customer base through effective networking, cold calling, and relationship-building strategies.
  • Enhanced client satisfaction by promptly addressing inquiries and providing accurate information on products and services.

Unarmed Security Officer

Securitas Security Services
10.2011 - 01.2016
  • Guard, patrol, or monitor premises, Answer alarms and investigate disturbances, Authorize entry or exit of individuals and Recognize public safety hazards
  • FTO (Field Training Officer), Resolve customer requests, questions and complaints regarding the Company’s services, Communicate with customers, patients and visitors via telephone or face to face
  • Perform other duties as assigned, display a positive and professional attitude at all times
  • Skills and Qualifications:
  • Lifting, Surveillance Skills, Deals with Uncertainty, Judgment, Objectivity, Dependability, Emotional Control, Integrity, Safety Management, Professionalism, Reporting Skills
  • Fielding telephone calls, receiving and directing visitors, word processing, creating spreadsheets and filing
  • Performs basic clerical tasks, operates standard office equipment
  • Sorts and distributes incoming and outgoing mail and operates manual and electronic mailing equipment.
  • Completed full building and grounds patrols to spot and investigate concerns.
  • Prevented crimes by immediately reporting all unusual, unauthorized and illegal activity on premises.
  • Verified each individual's right to enter restricted areas and denied access to unauthorized persons.
  • Responded quickly to incidents and assessed active situations for security concerns.

Shipping and Receiving Clerk

Columbus Technical College
03.2011 - 05.2011
  • Communicate with customers, employees, and other individuals, Answer telephones, direct calls, and take messages, Compile, copy, sort, and file records, Operate office machines and Compute, record, and proofread data.
  • Improved shipping efficiency by streamlining packing procedures and optimizing workstation layouts.
  • Reduced shipping errors through meticulous inspection of outgoing packages and double-checking labels.
  • Enhanced warehouse organization by implementing a barcode tracking system for incoming shipments.
  • Expedited delivery times by collaborating closely with carriers to schedule timely pickups and drop-offs for shipments.
  • Facilitated smooth communication between logistics partners, warehouses, and customers regarding shipment updates or delays for a seamless experience.

Education

High School Diploma -

Hallie Turner Private High School
Columbus, GA

High School Diploma -

Hardaway High School
Columbus, GA

Bachelors Degree - Forensic Science Technology

Strayer University
Columbus, GA
05.2016

Associates Degree - Criminal Justice

Virginia College
Columbus, GA
03.2014

Skills

  • Microsoft Word, Microsoft PowerPoint, Microsoft Publisher, Windows XP, Windows 8, Adobe Photoshop, HTML, Microsoft Excel, Windows 2000, XP, Vista, JavaScript and any basic computer functions
  • HIPAA
  • Medical Terms and Procedure Knowledge
  • Microsoft Office
  • Insurance Calculation
  • Medical Terminology
  • Benefits Guidelines
  • Claims review
  • Accuracy and Precision
  • Claims
  • Regulatory Compliance
  • Data entry proficiency
  • Customer Service
  • Time Management
  • Relationship Building
  • Policy Review
  • Coverage Determination
  • Multitasking Abilities
  • Team building
  • Interpersonal Communication
  • Prior authorization processing
  • Documentation abilities
  • Information Verification
  • Problem-Solving
  • Insurance Coverage Verification
  • Professional Demeanor
  • Decision-Making
  • Attention to Detail
  • Adaptability and Flexibility
  • Professionalism
  • Interpersonal Skills
  • Denied claims identification
  • Reliability
  • Self Motivation
  • Documentation processing
  • Effective Communication
  • Written Communication
  • Claims adjustment
  • Claims Processing

Timeline

Claims Processor

Anthem Inc.
10.2022 - Current

Customer Service Representative

Anthem, Inc.
01.2019 - Current

Escalations Agent (Floor Supervisor)

Total Systems
01.2017 - 11.2018

Unarmed Security Officer

Securitas Security Services
10.2011 - 01.2016

Shipping and Receiving Clerk

Columbus Technical College
03.2011 - 05.2011

High School Diploma -

Hallie Turner Private High School

High School Diploma -

Hardaway High School

Bachelors Degree - Forensic Science Technology

Strayer University

Associates Degree - Criminal Justice

Virginia College

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Erica Jones-Davidson