Fiama Collins
Summary
Proven track record of success in determining eligibility and resolving complex cases. Works professionally with clients to develop and implement successful strategies for maximizing services and benefits. Skilled in problem-solving and identifying solutions meeting clients' needs.
Overview
9
9
years of professional experience
Work History
Medical Claims Processor
Aetna
02.2022 - Current
- Explained benefits and claims to plan participants in easy to understand terms.
- Handled all assigned claims promptly and effectively.
- Ran all claims reports through company system.
- Determined proper policy coverages and applied appropriate claims practices to reach case resolution.
- Escalated all claims to necessary departments and reviewed all claims documents for accuracy.
- Acted as a liaison in reference to all severe incident reports, reinsurance reports and all other case needs.
- Built long last client relationships and prioritized outstanding customer service.
- Identified and resolved discrepancies between patient information and claims data.
- Followed up with customers on unresolved issues dealing with their claim.
- Reduced errors in claims submissions through meticulous attention to detail and thorough review processes.
Insurance Claims Representative
Future Care Consultants
04.2020 - 02.2022
- Reported claims to insurance companies and gathered the adjuster information and claim number.
- Kept Accurate record of claim recoveries in the company system
- Generated all claims acknowledgement documents.
- Resolved claims by approving or denying documentation, calculating benefits due and determining compensation settlement.
- Contacted injured parties and legal representatives to negotiate final settlements for claims.
- Managed high-volume transactions, ensuring accuracy and timeliness for optimal results.
Authorization Specialist
Healthfirst
02.2015 - 04.2020
- Verify appropriate ICD-10 codes for authorizations and claims.
- Improved patient satisfaction by streamlining authorization processes and ensuring timely responses to inquiries.
- Enhanced departmental efficiency with thorough knowledge of insurance guidelines and medical terminology.
- Collaborated with interdisciplinary teams to develop comprehensive care strategies for optimal patient outcomes.
- Served as a reliable liaison between healthcare providers, families, and patients to ensure seamless coordination of care efforts.
- Reduced processing errors by regularly reviewing and updating internal procedures and guidelines for the team.
Education
Business Administration
Strayer University
12.2025
High School Diploma -
Olympic High School
Charlotte, NC06.2010
Skills
- Documentation Review
- Coverage Assessments
- Accident Investigations
- Settlement Determinations
- Data Entry
- Verbal and Written Communication
- Claim Amount Calculations
- New Policies Processing
- Eligibility Determination
- Coverage Determination
- Customer Service
- Microsoft Office
- Data Analysis
Timeline
Medical Claims Processor
Aetna
02.2022 - Current
Insurance Claims Representative
Future Care Consultants
04.2020 - 02.2022
Authorization Specialist
Healthfirst
02.2015 - 04.2020
Business Administration
Strayer University
High School Diploma -
Olympic High School
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