Detail-oriented Medical Claims Processor with 17 years of experience in healthcare revenue cycle management. Skilled in processing complex medical claims, resolving denials, verifying eligibility, and supporting accurate reimbursement.
Overview
21
21
years of professional experience
7
7
years of post-secondary education
Work History
Customer Service Representative
SEDGWICK
Remote
03.2024 - 11.2025
Respond to customer requests for products, services, and company information.
Sought ways to improve processes and services provided.
Respond to customer requests, offering excellent support and tailored recommendations to address needs.
Provide excellent customer care by responding to requests, assisting with product selection and handling ordering functions.
Claims Adjuster
CNC Catastrophe & National Claims
Remote
02.2022 - 03.2024
Conducted prompt, thorough and fair investigation by obtaining relevant facts to determine coverage, origin and extent of loss.
Negotiated settlement of claims of varying complexity and peril, achieving prompt, fair and equitable settlement of claim in cases of policy liability.
Reviewed and utilized financial statements to adjust moderately-sized business interruption losses subject to claims and potential payouts.
Auto Express Virtual
Eberls Claim Service
Remote
10.2021 - 02.2022
Worked productively in fast-moving work environment to process large volumes of claims.
Followed up with customers on unresolved issues.
Improved customer satisfaction by providing timely and accurate information on claim status and resolution.
Conducted detailed assessments of claims documents, ensuring accuracy and completeness before submission for approval.
Claim Specialist/Processor
The Infirmary Health Systems
Mobile
02.2005 - 09.2021
Manage high-volume claim workloads, ensuring accurate and timely processing from initial submission through final payment.
Partner with billing and coding teams to identify and correct coding, documentation, or data-entry errors to prevent denials.
Contact payouts, patients, and providers to obtain missing information, resolve claim issues, and ensure clean claim submission.
Complete account reconciliation, variance resolution, and monthly financial reporting to support revenue cycle operations.
Education
Associate Of Applied Science - Business Administration
Rasmussen College - Topeka
Remote
08.2017 - 10.2019
Certificate - Medical Billing And Coding
Virginia College
Mobile , AL
09.2004 - 10.2005
High School Diploma -
John S Shaw High School
Mobile, AL
09.1994 - 05.1998
Skills
Medical claim adjudication & processing
Insurance verification & eligibility
Denial management & appeals
Accounts Receivable (A/R) follow-up
Medical coding knowledge (ICD-10, CPT, HCPCS)
Healthcare compliance & HIPPA
Billing software & systems (Epic, Clearinghouses, Payor portals)
Data entry, accuracy & documentation
Remote collaboration & communication tools
Claim payment posting & tracking
Timeline
Customer Service Representative
SEDGWICK
03.2024 - 11.2025
Claims Adjuster
CNC Catastrophe & National Claims
02.2022 - 03.2024
Auto Express Virtual
Eberls Claim Service
10.2021 - 02.2022
Associate Of Applied Science - Business Administration