GERRIAH PIGGEE
Red Oak,TX
Summary
Detail-oriented claims professional with extensive experience in claims processing, eligibility review, medical documentation analysis, insurance verification, and customer service. Expertise in researching and resolving complex claim issues while maintaining meticulous records and ensuring compliance with company policies and HIPAA regulations. Demonstrated ability to manage high-volume workloads effectively, fostering clear communication with customers and providers. Consistently meets quality and productivity standards in remote environments, showcasing a strong commitment to excellence in service delivery.
Overview
9
9
years of professional experience
Work History
Insurance Verification Specialist
New York Life Insurance
Texas - Remote
03.2020 - 05.2025
- Reviewed and verified insurance eligibility and medical documentation, maintaining rigorous standards for accuracy and adherence to compliance requirements.
- Managed interactions with healthcare providers and employees, focusing on eliminating bottlenecks in processing workflows.
- Optimized internal systems by implementing procedures for updating claim records, significantly improving the accuracy of benefit information and return-to-work statuses.
- Guided employees through eligibility leave processes, clarifying timelines and documentation needs while maintaining strict adherence to HIPAA regulations.
- Executed management of 75+ active claims at once, consistently meeting high productivity and quality expectations.
- Streamlined insurance verification procedures to support timely and accurate claims resolution.
- Coordinated efforts with healthcare providers to obtain required patient information for effective policy validation.
Healthcare Claims Processor
United Health Group
Texas-remote
03.2018 - 02.2020
- Performed detailed examination of denied and pending claims, utilizing account history documentation and plan information to facilitate precise claim resolution.
- Analyzed healthcare claims and associated documentation to facilitate accurate reimbursement processes.
- Managed communication with members and providers, ensuring timely updates on claims, insurance verification, and benefit inquiries for a portfolio of 60+ accounts weekly.
- Executed daily entry of detailed claim notes and updates into internal claims systems, enhancing data integrity and accessibility.
- Monitored and upheld a 97% quality score, demonstrating attention to detail in a rapidly changing healthcare claims environment.
- Monitored and validated claims to ensure alignment with regulatory guidelines and company policy requirements.
- Reviewed claim submissions meticulously, pinpointing inaccuracies and initiating corrective actions as required.
Loan Processor
Ace Cash Express
Texas
10.2016 - 03.2018
- Reviewed and corrected incomplete applications while liaising with customers to collect essential documentation for comprehensive evaluation.
- Oversaw the integrity of customer records while updating payment activities, account changes, and loan details in organizational systems.
- Resolved loan-related inquiries and payment arrangements for 40+ customers daily, ensuring high-quality support and customer satisfaction.
- Met stringent turnaround times by adhering to accuracy and compliance protocols in high-demand situations.
- Conducted thorough reviews of loan applications, confirming accuracy and completeness to uphold regulatory compliance.
- Conducted thorough processing and verification of financial documents with proprietary software to facilitate timely loan approvals.
Education
High School Diploma -
Desoto High School
07-2016
Skills
- Experience with CRM platforms
- Accurate data entry
- Client account management
- Claims management
- Effective time management
- Healthcare claims processing
- Eligibility evaluation
- Claims evaluation
- Proficient in Microsoft Office
- Records Management
- Medical record evaluation
- Customer Service
- HIPPA Compliance
- Written Communication
- Attention to Detail
- Problem solving
- Regulatory Compliance
Timeline
Insurance Verification Specialist
New York Life Insurance
03.2020 - 05.2025
Healthcare Claims Processor
United Health Group
03.2018 - 02.2020
Loan Processor
Ace Cash Express
10.2016 - 03.2018
High School Diploma -
Desoto High School