Jeniya A. Helm
Conroe
Summary
Dynamic Claims Processing Specialist with Everise INC, adept at enhancing accuracy in claims processing and resolving discrepancies. Proven expertise in claims trend analysis and exceptional customer service, ensuring timely reimbursements and compliance with insurance regulations. Committed to maintaining confidentiality and fostering teamwork to achieve operational excellence.
Overview
4
4
years of professional experience
Work History
Claims Processing Specialist ( REMOTE)
Everise INC
Plantation
06.2025 - Current
- Reviewed claim submissions for accuracy and completeness.
- Communicated updates to clients regarding their claim status.
- Reviewed and processed medical and dental claims to ensure accuracy of information.
- Analyzed patient accounts to identify underpayments or overpayments.
- Continuously monitored changes in industry standards related to health care reimbursement practices.
- Resolved discrepancies between provider's billings and insurance contracts.
- Attended training sessions to stay current on new policies or procedures for claim processing.
- Adhered to HIPAA privacy standards when handling confidential patient information.
- Performed data entry into various systems related to claims processing tasks.
- Verified eligibility, benefits, authorization requirements for services rendered.
- Reviewed submitted documentation from providers for completeness prior to submitting claims.
- Applied knowledge of insurance plans, regulations and guidelines in adjudicating claims.
- Worked collaboratively with other departments such as customer service and coding staff.
- Verified claim data correctness in preparation for processing.
- Addressed customer inquiries to provide information and explanations on coverage and terms, expediting claims.
- Coordinated benefits with medical insurance plans and Medicare providers.
- Reviewed history records to determine benefit eligibility for services.
- Researched medical claims for validity to resolve discrepancies.
- Processed medical claims using electronic health record systems and insurance software.
- Reviewed claim submissions for accuracy and compliance with insurance policies.
- Communicated with healthcare providers to clarify claim details and resolve discrepancies.
- Ensured timely submission of claims to meet company standards and deadlines.
- Verified accuracy of provider data entered into the system including tax ID numbers, NPI numbers, address changes .
- Submitted electronic claims through various clearinghouses when necessary.
- Stayed current on HIPAA regulations, benefits claims processing, medical terminology and other procedures.
- Worked collaboratively with providers' offices to ensure timely reimbursement on submitted claims by providing missing documentation or correcting errors that caused delays in payment processing.
- Investigated discrepancies in medical billing information such as incorrect codes or amounts due.
- Researched claim denials and appeals to determine appropriate resolution.
- Performed Quality Assurance checks on processed claims ensuring all edits were resolved prior to submitting them for adjudication and payment.
- Identified potential fraud cases based on analysis of submitted claims data and escalated accordingly.
- Responded promptly to customer inquiries regarding claim status or other issues.
- Updated system records with payment information received from insurance companies or patients directly.
- Checked documentation for appropriate coding, catching errors and making revisions.
- Handled billing related activities focused on medical specialties.
- Assisted claimants, providers and clients with problems or questions regarding claims.
- Processed claims efficiently using proprietary software systems.
- Maintained detailed records of all claims processed daily.
- Identified trends in denials by analyzing reports from the system database.
- Maintained accurate records of all claim processing activities in a timely manner.
- Monitored aged claims on a regular basis to ensure timely resolution of disputes.
- Processed claims according to established quality and production standards and made corrections and adjustments to solve problems.
- Reviewed and processed incoming insurance claims to ensure accuracy and completeness.
- Maintained confidentiality of policyholder information in compliance with HIPAA regulations.
- Processed claims efficiently using Everise INC's proprietary software systems.
- Communicated with clients to gather necessary information for claims processing.
- Maintained accurate records of all claims and associated correspondence.
BUSINESS OWNER/ MAID CLEANER EMPLOYEE
MARIES PRO CLEANING
Houston
07.2024 - 06.2025
- Cleaning residential or commercial spaces, focusing on tasks like dusting, Vacuuming, mopping, bathroom and kitchen cleaning, and changing linens.
- They also might handle basic laundry, organizing, and de-cluttering.
- Specific duties may include:
- General Cleaning: Sweeping, mopping, and vacuuming floors.
- Surface Cleaning: Dusting furniture, shelves, and other surfaces.
- Bathroom Cleaning: Cleaning toilets, sinks, showers, and bathtubs.
- Kitchen Cleaning: Washing dishes, wiping down counters and appliances.
- Laundry and Linen: Changing bed linens, washing and folding clothes.
- Trash and Recycling: Emptying trash cans and recycling bins.
- Organization and Tidying: Decluttering, organizing, and making beds.
- Window Cleaning: Cleaning interior windows.
- Deep Cleaning: Deep cleaning of carpets, ovens, and other specific areas.
- Managed daily operations of a residential cleaning service.
- Communicated effectively with clients to understand their cleaning needs.
- Created a customer service policy to ensure customers were satisfied with products or services.
- Ensured compliance with all local laws and regulations related to the business operations.
- Sanitized bathrooms including sinks, toilets, showers and tubs, countertops, mirrors and floors.
- Assisted with laundry duties as needed.
TRUCK DRIVER
AMERIE ANGELS TRANSPORT LLC
Houston
09.2021 - 07.2024
- Improved on-time delivery rates by effectively planning and executing efficient driving routes.
- Enhanced customer satisfaction by maintaining open communication with clients during pickups and deliveries.
- Reduced fuel expenses through careful route planning and diligent monitoring of vehicle maintenance needs.
- Increased safety standards by conducting thorough pre-and post-trip inspections of the truck and trailer.
- Provided timely, accurate documentation for all freight shipments, contributing to smooth logistical operations.
- Maintained a clean driving record while adhering to company policies and federal regulations for transportation safety.
- Developed strong relationships with dispatchers, ensuring optimal job assignments based on skillset and geographical familiarity.
- Demonstrated adaptability in adjusting to unforeseen road conditions or traffic delays, maintaining timely deliveries despite challenges.
- Safeguarded cargo integrity by regularly checking load securement during transport and promptly addressing any issues that arose.
- Utilized GPS technology and mapping software effectively to identify the most efficient driving routes consistently throughout assignments.
- Achieved high levels of customer satisfaction through professional interaction with clients at pickup and delivery points, representing the company positively at all times.
Education
Certificate - Project Management
Google University Career Certificate
San Francisco, CA08-2025
Health Care Administration - GENERAL STUDIES
FAYETTEVILLE TECHNICAL COMMUNITY COLLEGE
Fayetteville, NC12.2018
High School Diploma -
Bertie High School
Windsor, NC05.2014
Skills
- Project Management
- Exceptional Customer Service
- Teamwork
- Time Management
- Leadership
- Effective Communication
- Critical Thinking
- Transportation Safety
- Load Security
- Document Management
- Equipment Operation
- Cargo Handling
- Data Entry
- Claims processing software
- Problem resolution
- Team collaboration
- Data entry proficiency
- Insurance regulations
- Verbal communication
- Confidentiality
- Research
- Medical terminology
- Professionalism and ethics
- Claims
- Accuracy and precision
- Claims trend analysis
- Critical evaluation
- Claims review
- Analytical thinking
- Microsoft office
- Office equipment operation
- Multitasking Abilities
- Eligibility determination
- Research skills
- Payment and investigation escalations
- Documentation
- Claims adjustment
- Denied claims identification
- Policy requirements and eligibility
- Excellent communication
- Insurance plan verification
- Decision-making
- Documentation processing
Timeline
Claims Processing Specialist ( REMOTE)
Everise INC
06.2025 - Current
BUSINESS OWNER/ MAID CLEANER EMPLOYEE
MARIES PRO CLEANING
07.2024 - 06.2025
TRUCK DRIVER
AMERIE ANGELS TRANSPORT LLC
09.2021 - 07.2024
Certificate - Project Management
Google University Career Certificate
Health Care Administration - GENERAL STUDIES
FAYETTEVILLE TECHNICAL COMMUNITY COLLEGE
High School Diploma -
Bertie High School