Erin Evans
6100 Browning Drive Apt#6206,TX
Summary
Experienced claims adjuster with over 15 years of experience in healthcare. Excellent reputation for resolving problems and improving customer satisfaction.
Overview
6
6
years of professional experience
Work History
Claims Specialist
Quest Diagnostics
Dallas, TX
03.2021 - Current
- Reviewed new files to determine current status of injury claim and to develop plan of action.
- Implemented improvements in manual and electronic billing procedures.
- Followed up with customers on unresolved issues.
- Modeled exceptional customer service skills and appropriate diagnostic sales techniques to team members.
- Reported policy changes and company conditions affecting customer satisfaction.
- Communicated effectively with staff, including members of operations, finance and clinical departments.
- Prepared insurance claim forms or related documents and reviewed for completeness.
- Maintained confidentiality of patient finances, records and health statuses.
- Tracked all pending authorizations to resolve discrepancies and avoid revenue loss.
- Presented insurance options to customers in order to close sales on new policies.
- Reviewed outstanding requests and redirected workloads to complete projects on time.
- Coordinated with contracting department to resolve payer issues.
- Addressed average of 90% customer inquiries and complaints each week
- Addressed average of 280 customer inquiries and complaints each week.
Claims Adjuster
Pathgroup
Jackson, MS
01.2016 - 01.2021
- Interviewed agents and claimants to correct errors or omissions and investigate questionable claims
- Examined claims forms and other records to determine insurance coverage
- Drafted investigative reports covering all phases of investigation in each case
- Evaluated all evidence with ultimate goal of creating positive outcomes for client's claims
- Organized, planned, and documented materials for medical claims
- Reviewed and analyzed suspicious and potentially fraudulent insurance claims
- Synthesized data into comprehensive quarterly written reports for management
- Monitored 100-clients caseload for each quarter
- Ran 80 special projects and initiatives at both local and regional level
Education
Health Administration
Jackson State University
Jackson, MS12.2022
Associate of Arts - General Studies
Holmes Community College
Goodman, MS12.2013
Skills
- Coverage assessments
- Documentation Review
- Claims Adjustments
- Insurance Knowledge
- Documentation abilities
- Reporting skills
- Account management
- Verbal and written communication
- Self-motivated professional
- Supervision
- Computer skills
- Conflict resolution
- Cultural awareness
- Written Communication
- Training & Development
- Organization and Time management
Timeline
Claims Specialist
Quest Diagnostics
03.2021 - Current
Claims Adjuster
Pathgroup
01.2016 - 01.2021
Health Administration
Jackson State University
Associate of Arts - General Studies
Holmes Community College
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