Javion Edwards
Dallas
Summary
Detail-oriented claims specialist skilled in investigating discrepancies and ensuring accurate claims processing. Strong commitment to customer service excellence demonstrated through effective communication and problem resolution. Proven ability to navigate complex policies while maintaining high levels of accuracy.
Overview
1
1
Certification
Work History
Insurance Claims Specialist
McKesson
Richardson
2025 - 2026
- Reviewed customer insurance claims to ensure accuracy and completeness of information.
- Determined liability, compensability, and benefits due on each claim.
- Investigated discrepancies in claims and resolved issues promptly.
- Addressed and resolved customer complaints regarding insurance claim processing.
- Communicated with clients, insurers, and vendors to provide updates on claim status.
- Gathered documentation from clients to support claims processing.
- Managed special projects to improve workflow efficiency.
Claims Adjuster
Allcat Claims Service, LLC
San Antonio
2023 - 2025
- Assessed insurance claims of varying complexities, including complex and large losses, to determine appropriate coverage and settlements
- Scoping the loss, assessing damages, interpreting policy and making claim decisions
- Conducted thorough investigations of claim damages to ensure accurate assessments and timely resolutions
- Negotiating with claimants to reach a settlement
- Authorizing payments within the company's designated authority level
- Examining claim forms to determine if the policy covers the loss
- Processed additional living expense (ALE) and medical claims for policyholders.
- Developed positive relationships with customers, contractors, PAs, attorneys, and engineers to facilitate smooth claim processes
- Worked on Liberty Mutual accounts as well with a special group during CAT
- Demonstrated independence in completing tasks without direct supervision.
Patient Intake Coordinator
Hickory Trail Hospital
DeSoto
2021 - 2023
- Delivered exceptional customer service to enhance patient satisfaction
- Clarified billing procedures to ensure patient understanding and transparency
- Confirm policy status and coverage details
- Conducted insurance checks to confirm coverage
- Maintained organized authorization logs and followed up on pending requests to streamline processing
Customer Service Representative
Iqor-Richardson
Remote
2018 - 2021
- Educated customers on available products and services, driving engagement and sales
- Simplified billing explanations for customers, enhancing understanding and satisfaction
- Processed and collected payments for business customers
- Verified correct credits and adjustments for customer accounts
- Scheduled follow-ups for appointments to enhance customer service
- Issued bill reprints to customers upon request
- Oversaw business accounts, fostering strong client relationships and ensuring retention
- Guided new employees through training protocols for account handling
Customer Service Representative
Stericycle
North Richland Hills
2016 - 2018
- Delivered diverse services to address customer inquiries
- Communicate effectively and professionally with internal and external contacts
- Adhered to protocols and specific client requirements to ensure compliance
- Processed over 60 claims daily to maintain service efficiency
- Verify personal information
- Dispatch shipments and schedule appointments
- Monitored shipment progress to ensure timely arrivals
Insurance Verification Specialist
TeleTech (BCBS)
Ennis
2014 - 2016
- Take full ownership to resolve customer questions and issues
- Process claims for customers
- Resolved billing issues and processed payments for customers
- Followed up on unpaid account balances and resolved claims and EOB denials to ensure timely payments
- Reviewed EOBs to confirm proper reimbursement and identify discrepancies
- Review and research insurance correspondence and make necessary corrections to ensure claims have been paid
- Adhere to HIPPA guidelines for Protected Health Information (PHI), Sensitive Personal Information (SPI) and Business Confidential Information (BCI)
- CPT coding and ICD-10 experience
- Gained extensive experience in medical billing and coding practices
- Operated multiple software systems simultaneously to enhance workflow efficiency
- Reviewed appeals data for compliance with state and federal regulations, ensuring adherence to HIPAA, ERISA, ACA, Medicare guidelines, and DOI standards
- Pro actively identify and raise areas for policy improvement to prevent further customer issues
Education
High school diploma -
Emmett J Conrad High School
Dallas, TXSkills
- Claims calculation
- Regulatory guideline interpretation
- Document review
- Reconcile discrepancies
- Settlement negotiation
- Risk management
- Account management
- Client relationship management
- CRM system knowledge
- Microsoft Excel
- Microsoft Word
- Analytical skills
- Analytical thinking
- Problem solving
- Strong attention to detail
- Dispute resolution
- System navigation
- Organization
- Collaboration techniques
- Writing skills
- Data entry
- Research
Certification
- Driver's License
- Property & Casualty License
Additional Information
Authorized to work in the US for any employer
Affiliations
- Mortgage License for NMLS
- Pilot and Allstate training
- Adjust U training class
Accomplishments
- Xactimate Training
Timeline
Insurance Claims Specialist
McKesson
2025 - 2026
Claims Adjuster
Allcat Claims Service, LLC
2023 - 2025
Patient Intake Coordinator
Hickory Trail Hospital
2021 - 2023
Customer Service Representative
Iqor-Richardson
2018 - 2021
Customer Service Representative
Stericycle
2016 - 2018
Insurance Verification Specialist
TeleTech (BCBS)
2014 - 2016
High school diploma -
Emmett J Conrad High School