Grace Nyameshie
Woodbridge,VA
Summary
Dedicated professional with over four years in claims processing and customer service. Expertise in analytical skills and teamwork, consistently delivering accurate claims evaluations and fostering strong client relationships to improve satisfaction and operational outcomes.
Overview
7
7
years of professional experience
1
1
Certification
Work History
Customer Service/Health Care Claim Specialist
Tristate Quality Care
Alexandria, Virginia
04.2020 - 05.2024
- Evaluated claims for accuracy and compliance with company policies.
- Reviewed documentation to determine claim eligibility and validity.
- Communicated with clients to gather necessary information for claims processing.
- Coordinated with insurance adjusters to resolve claim discrepancies.
- Maintained detailed records of claims activities and communications.
- Assisted in training new staff on claims procedures and best practices.
- Utilized claims management software to track and manage claims efficiently.
- Maintained detailed records of all claim activities including notes about conversations with claimants or representatives.
- Maintained knowledge of policies and procedures and insurance coverage benefit levels, eligibility systems and verification processes.
- Provided customer service by responding promptly to inquiries from claimants regarding their benefits or coverage.
- Reviewed and analyzed insurance claims to determine validity, completeness, accuracy, and eligibility for payment.
- Assisted with filing appeals on denied claims with insurance companies.
Sales Coordinator
Sears
Alexandria, Virginia
04.2017 - 05.2020
- Coordinated daily sales activities to support store operations and customer engagement.
- Supported sales team by delivering current territory sales data and costing information.
- Developed key customer relationships to increase sales and enhance overall client satisfaction.
- Provided administrative support to the sales team including scheduling meetings, preparing presentations and managing email correspondence.
- Engaged customers in conversation to effectively determine needs and recommend best products and services.
- Provided assistance throughout the entire sales process from initial contact through post-sale follow-up activities.
- Maintained an up-to-date database of prospective clients and their contact information.
Education
Associate of Science - Cyber Security in Management
University of Maryland Global Campus
Hyattsville, MDSkills
- Claims processing
- Client communication
- Customer service
- Complex claims consulting
- Claims trend analysis
- Documentation review
- Verbal communication
- Allocating claims
- Claims analysis
- Teamwork and collaboration
- Communication skills
Languages
English
Professional
Certification
Security+ Certificate, HHA Certificate
Timeline
Customer Service/Health Care Claim Specialist
Tristate Quality Care
04.2020 - 05.2024
Sales Coordinator
Sears
04.2017 - 05.2020
Associate of Science - Cyber Security in Management
University of Maryland Global Campus