Joshtishua Larkins
Tampa,FL
Summary
Detail-oriented customer service representative with expertise in claims processing and data entry. Proven ability to manage high-volume inquiries while ensuring accurate documentation and timely resolution of issues. Strong communicator with exceptional organizational skills and a commitment to maintaining confidentiality and professionalism. Demonstrated success in reviewing claims and keeping records up to date.
Overview
12
12
years of professional experience
Work History
Insurance Claims Specialist & Customer Service Rep
Elevance
12.2019 - Current
- Review and process medical, hospital, physician,and other healthcare claims.
- Verify member eligibility, benefits, coverage, deductibles, copayments, coinsurance, and authorization requirements.
- Review medical codes, including ICD-10, CPT, and HCPCS, as applicable.
- Adjudicate claims according to insurance policies, provider contracts, benefit plans, and payer guidelines.
- Identify coding errors, duplicate claims, missing information, and potential billing discrepancies.
- Request additional documentation or information when necessary.
- Calculate patient responsibility and insurance payment amounts accurately.
- Process claim adjustments, denials, reprocessing requests, and corrections.
- Research and resolve claim inquiries from providers, members, and internal departments.
- Maintain accurate documentation and detailed claim records.
- Follow HIPAA requirements, payer policies, regulatory standards, and company procedures.
- Meet established productivity, quality, accuracy, and turnaround-time requirements.
- Prepares freeform letters to insureds and/or their representatives, both during and after completion of claim evaluation, which outlines and support the status of the evaluation and/or claim determination. Frequently engages in conversations with our insureds and/or their representatives, in which it is necessary to demonstrate active listening and conduct information gathering to be able to articulate the claims decision upon the completion of an evaluation, as well as being able to explain pertinent policy language in detail.
- Addresses and resolves escalated customer complaints in a timely and thorough manner. When required, drafts written responses to Department of Insurance and Presidential complaints. Identifies and refers appropriate matters to legal counsel
Customer Service Representative
Wipro
03.2017 - 11.2019
- Handled customer inquiries, complaints, billing questions and payment extension/service request. Handled 70+ Calls daily, with duties including signing up new customers, retrieving customer data, presenting relevant product information, and cancelling services.
- Quickly and effectively solved customer challenges to include following up to ensure remediation. Educated customers on health insurance plans while adhering to HIPAA regulations.
- Effectively communicated using customer friendly and appropriate language, to explain customer bills, payment issues and handled billing disputes.
Billing Specialist
OneTouch Direct
01.2015 - 03.2017
- Identify outstanding accounts
- Generate bills and invoices specific to customer accounts
- Deliver invoices to clients via digital and traditional mail services Process all payment using various pay services
- Send delinquent accounts to the collections department
- Respond to client inquiries
Education
High School Diploma -
Middleton High School
Tampa, FL01.2014
Skills
- Customer service and support
- Strong communication skills
- Active listening
- Multitasking abilities
- Problem solving
- Team collaboration
- Call center operations
- Insurance verification
- Medical terminology
Timeline
Insurance Claims Specialist & Customer Service Rep
Elevance
12.2019 - Current
Customer Service Representative
Wipro
03.2017 - 11.2019
Billing Specialist
OneTouch Direct
01.2015 - 03.2017
High School Diploma -
Middleton High School