John James
Clermont,Florida
Summary
Diligent Claims Processor versed in insurance processes and claims procedures. Offers great attention to detail and time management abilities to successfully handle large volumes of claims. Highly accurate and thorough with a focus on completing error-free work in line with processing guidelines.
Overview
7
7
years of professional experience
Work History
INSURANCE CLAIMS PROCESSOR
OSCAR HEALTH
12.2021 - Current
- Processes incoming work associated with Claims, Eligibility, Provider Data, and Credentialing operations following standard operating procedures.
- Analyzing insurance information, performing data entry, handling insurance claims' reimbursement, and determining whether a claim is appropriate to be processed or denied.
- Manages escalations and resolutions with external vendors to ensure appropriate turnaround times.
- Works on the finance team handling claim payments, processing checks, ensuring the checks are not fraudulent, sending fraudulent checks to escalations, and processing checks to the appropriate provider or member.
- Improved customer satisfaction by providing prompt, courteous, and knowledgeable assistance during the claims process.
- Reduced processing time for each claim by utilizing efficient data entry techniques and attention to detail.
- Increased accuracy in claims processing by verifying policyholder information and cross-referencing with available records.
- Ensured timely payments to policyholders by efficiently managing a high volume of claims.
- Exhibited strong organizational skills in managing multiple tasks simultaneously, resulting in consistently meeting deadlines.
- Maximized claim efficiency by thoroughly reviewing and analyzing insurance claims.
CUSTOMER SERVICE CONSULTANT
PROGRESIVE INSURANCE
06.2021 - 12.2021
- Upselling, including gaining commitment for potential additional insurance products including renter's and homeowner's policies, and offering to add options like paperless billing or electronic payments
- Adding/deleting vehicles and drivers
- Processing renewals, cancellations, reinstatements, and payments
- Answering questions about policy coverage, rate changes, and much more
- Managing 60-70 calls daily and expected to meet several metrics, including goals for upselling, accuracy, and call length/number of calls per day.
OFFICE COORDINATOR
CLEVELAND CLINIC FLORIDA
01.2021 - 05.2021
- Answering between 50-70 calls a day, triaging, scheduling appointments, diagnostic procedures, and obtaining referrals/authorizations if needed for the patients
- Supports clinic operations by direct involvement with physicians and nurses, also managing their schedules.
PATIENT SERVICE SPECIALIST
CLEVELAND CLINIC FLORIDA
12.2016 - 01.2021
- Provides a comprehensive, proactive, and 'Patients First' experience for the patients and visitors
- Demonstrates outstanding customer service skills and uses evolving technology to manage a wide range of patient requests including appointment scheduling, patient registration, wayfinding, answering general questions, and meeting needs
- Always represents Cleveland Clinic in a professional, caring, and helpful manner
- Ensures stellar and efficient patient experience while reducing financial loss and ensuring compliance.
Education
ASSOCIATE IN ARTS -
BROWARD COLLEGE
COCONUT CREEK, FL06.2016
Skills
- Proficient in Google Sheets and Excel
- Detailed Oriented
- Support Specialist
- Team Collaboration and Leadership
- Workflow Analysis and Optimization
- Jira
- Epic
- Appian
- Documentation Review
- Training and guiding team members in workflows
- Ability to execute projects to improve workflows
- Passion for energetic and fast-paced environments
- Self-learner who thrives in the opportunity to take initiative
- Demonstrated ability to learn and adapt to new technologies quickly
- Clear communicator with the ability to break down complex problems and formulate digestible solutions
- Data Entry Proficiency
- Verbal Communication
- Claims Analysis
Timeline
INSURANCE CLAIMS PROCESSOR
OSCAR HEALTH
12.2021 - Current
CUSTOMER SERVICE CONSULTANT
PROGRESIVE INSURANCE
06.2021 - 12.2021
OFFICE COORDINATOR
CLEVELAND CLINIC FLORIDA
01.2021 - 05.2021
PATIENT SERVICE SPECIALIST
CLEVELAND CLINIC FLORIDA
12.2016 - 01.2021
ASSOCIATE IN ARTS -
BROWARD COLLEGE
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