JAREE Duren
Ludowici
Summary
Experience Benefit Claims Specialist successful at managing high caseloads in fast-paced environments. Organized, driven and adaptable with excellent planning and problem-solving abilities. Offering 2 years of experience and willingness to take on any challenge.
Overview
6
6
years of professional experience
Work History
Annuity Specialist
Prudential Financial
05.2022 - Current
- Resolved customers' questions by answering inbound calls, emails and texts.
- Utilized internal systems to provide service to callers.
- Adapted and prioritized work to support customers.
- Handled complaints competently by listening, asking questions to clarify requests and relating empathetically.
- Applies medical necessity guidelines, determine coverage, complete eligibility verification, identify discrepancies, and applies all cost containment measures to assist in claim adjudication process.
- Reviewed new files to determine current status of injury claim and to develop plan of action.
- Delivered exceptional customer service to every customer by leveraging extensive knowledge of products and services and creating welcoming, positive experiences.
- Conducted full claim investigations and reported updates and legal actions.
- Investigated and resolved customer inquiries and complaints quickly.
- Responded proactively and positively to rapid change.
- Met customer call guidelines for service levels, handle time and productivity.
- Maintained up-to-date knowledge of product and service changes.
- Proofs claim or referral submission to determine, review, or apply appropriate guidelines, coding, member identification processes, provider selection processes, claim coding, including procedure, diagnosis and pre-coding requirements.
- Modified, updated and processed existing policies
- Completed data entry tasks with accuracy and efficiency.
- Compiled data and reviewed information for accuracy prior to input.
- Consistently process assigned routine transactions within the established service level agreements
- Understand the difference between qualified and non-qualified annuity contracts and the transactions allowed for both.
- Educated clients on insurance policies and procedures.
Patient Account Claims Analyst
Memorial Sloan Kettering (Virtual Business Office)
01.2022 - 08.2022
- Work in multiple system platforms including hospital billing portals, company billing portals, Electronic Health Record (EHR) systems and payer portals to resolve denied or outstanding claims
- Analyze data gathered during investigation and wrote report with findings and recommendations
- Looked at data to see what underlying principles were
- Follow up with claims utilizing various research methods including, determination of outstanding balance, online research, and telephone calls to payers surrounding claims status
- Interview with Multiple agents and claimants to correct errors or omissions and investigate questionable claims.
- Double checked patient payment information before sending collection notices.
- Performed internal audits and wrote reports based on outcomes.
Team Lead Manager
Amazon
01.2019 - 01.2022
- Provided excellent customer service, fostering strong relationships, retention, and satisfaction
- Spoke with over 100 customers daily about their concerns about products or services in order to resolve issues and increase sales
- Aided branding strategy by ensuring that product displays adhered to corporate guidelines
- I'm updating and filing new information into systems
- Increased regulatory compliance by accurately completing tasks and adhering to safety regulations
- Kept customers happy by implementing forward-thinking strategies that focused on meeting their needs and resolving their concerns.
- Developed and actualized customer service initiatives to decrease wait times.
- Evaluated employee performance and coached and trained to improve weak areas.
- Charged with staffing, performance management and reviews, coaching, mentoring, salary development and budget allocations.
- Increased customer satisfaction by resolving issues
AT&T
Retail Sales Associate
11.2017 - 12.2019
- Skilled at working independently and collaboratively in a team environment.
- Self-motivated, with a strong sense of personal responsibility.
- Proven ability to learn quickly and adapt to new situations.
- Worked well in a team setting, providing support and guidance.
- Excellent communication skills, both verbal and written.
- Proved successful working within tight deadlines and a fast-paced environment.
- Adaptable and proficient in learning new concepts quickly and efficiently.
- Paid attention to detail while completing assignments.
- Organized racks and shelves to maintain store visual appeal, engage customers, and promote specific merchandise.
- Helped customers locate products and checked store system for merchandise at other sites.
- Prepared merchandise for sales floor by pricing or tagging.
- Rotated stock and restocked shelves to maintain product availability and store appearance.
- Managed returns, exchanges and refunds in accordance with store policy.
Education
BBA - Business Administration
Savannah State University
12.2023
Certified Healthcare Assistant -Nurse Aid -
Savannah Technical College
Savannah, GA05.2014
High School Diploma -
Faith Baptist Christian Academy
Ludowici, GA05.2011
Skills
- Administrative support
- Verbal and written communication
- Interviewing ability
- HIPAA understanding
- Medical billing
- First aid trained
- Payment posting
- Medical terminology
- Time management
- Medical Coding
- ICD 10 Coding
- Corporate Policies and Procedures
- Medication Education
Timeline
Annuity Specialist
Prudential Financial
05.2022 - Current
Patient Account Claims Analyst
Memorial Sloan Kettering (Virtual Business Office)
01.2022 - 08.2022
Team Lead Manager
Amazon
01.2019 - 01.2022
AT&T
Retail Sales Associate
11.2017 - 12.2019
BBA - Business Administration
Savannah State University
Certified Healthcare Assistant -Nurse Aid -
Savannah Technical College
High School Diploma -
Faith Baptist Christian Academy
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