A hardworking and highly motivated professional with a passion for growth and efficiency. Eager to lend combined knowledge and skills to enhance business performance. Operates well in both individual and team capacities, leveraging a seasoned work ethic to quickly adapt to different processes and drive company objectives. Resourceful and results-driven, with a focus on meeting company needs and increasing service value.
Overview
20
20
years of professional experience
Work History
Claims Specialist
Community Health Choice
07.2023 - Current
Followed up with customers on unresolved issues.
Escalated files with significant indemnity exposure to supervisor for further investigation.
Reviewed new files to determine current status of injury claim and to develop plan of action.
Understood requirements for disputes, gathered evidence to support claims and prepared customer cases to handle appeals.
Monitored compliance with regulations and industry best practices to promote fair and proper treatment for insured customers.
Performed administrative duties by verifying documentation, researching facts and contacting other parties involved to determine fault percentages and minimize potential losses.
Reviewed insurance and claims documents to verify required information and secure any missing data for settlements.
Conducted risk evaluations on claims settlement proposals to encourage sound decision-making regarding settlement offers.
Responded to inquiries by answering questions, providing information and directing customers to appropriate resources.
Financial Aid Customer Support Specialist
Interfaith of the Woodlands
07.2017 - 05.2023
Delivered personalized customer service relating to questions and promptly resolved basic problems on customer accounts
Maintained knowledge of company products to provide helpful suggestions and recommendations to customers
Responded to telephone inquiries and complaints following standard operating procedures
Complied with corporate and regulatory policies regarding information confidentiality and privacy
Addressed customers courteously using suitable methods and problem-solving skills
Maintained logs and documentation to detail key information regarding incoming and outgoing calls
Assisted with training and mentoring new team members
Developed and maintained working knowledge of internal policies, procedures, and services to appropriately address customer issues.
Administrative Clerk
Mouser Container Services
01.2010 - 06.2017
Answered telephones to give information to callers, take messages, or transfer calls
Sorted, distributed, and tracked incoming and outgoing mail
Performed data entry and document scanning
Checked in drivers and logged in driving times
Obtained signatures for financial documents and internal and external invoices
Developed numerous spreadsheets to track both incoming and outgoing orders
Answered multi-line telephone system to direct calls and take messages
Computed, record and proofread data and other information, such as records, and reports
Managed calendars and arranged appointments.
Insurance Verification Specialist
Baylor College of Medicine
08.2004 - 12.2009
Addressed and resolved issues identified by billing staff related to eligibility and coverage
Answered questions from patients and clerical staff regarding coverage
Completed tasks in claim edits and account work queues
Verified insurance coverage and eligibility prior to appointments and procedures
Register's patients verified insurance and pre-certifies outpatient and inpatient surgery's
Generated patient-specific letters for insurance companies to ensure accurate reimbursement of services
Scheduled tests and procedures for patients, such as lab work and x-rays, based on physician orders
Maintained medical records, technical library, and correspondence files.