Summary
Overview
Work History
Education
Skills
Timeline
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Kaelyn Davis

San Antonio

Summary

Results-driven professional with comprehensive background in claims management and proven ability to streamline processes. Known for collaborative approach and adaptability to evolving needs, ensuring smooth operations and goal attainment. Highly proficient in data analysis and problem-solving, valued for reliability and commitment to excellence.

Overview

11
11
years of professional experience

Work History

Claims Processor

CVS Health
05.2020 - Current
  • Managed high volume of claims, prioritizing tasks to meet deadlines without sacrificing quality.
  • Reviewed and analyzed claims to ensure accuracy, completeness, and compliance with company policies.
  • Managed workload and priorities to meet claims processing meet deadlines.
  • Collaborated with cross-functional teams to resolve complex claims issues efficiently and effectively.
  • Utilized specialized software to process incoming claims, enter data and generate reports.
  • Followed up with customers on unresolved issues.

Claim Specialist

Anthem
10.2017 - 04.2020
  • Applies medical necessity guidelines, determines coverage, completes eligibility verification, identifies discrepancies, and applies all cost containment measures to assist in the claim adjudication process.
  • Ensures all compliance requirements are satisfied and all payments are made against company practices and procedures.
  • Identifies and reports possible claim overpayments, underpayments and any other irregularities.
  • Familiar with ICD and CPT coding.
  • Ability to multitask while working independently.

Team Lead

Jason Deli
08.2016 - 10.2017
  • Communicated with customers and team members to solve problems.
  • Worked extra shifts during busy periods and covered for call-in employees to maintain service levels.
  • Assisted customers by answering questions and fulfilling requests.
  • Processed both cash and card purchases and returns.
  • Received and processed customer payments.
  • Restocked and organized merchandise in front lanes.
  • Quickly and accurately counted drawers at start and end of each shift.
  • Helped customers complete purchases, locate items, and join reward Programs.

Customer Service Representative

Seaworld Parks & Resorts
05.2014 - 08.2016
  • Handled customer inquiries and suggestions courteously and professionally.
  • Actively listened to customers, handled concerns quickly and escalated major issues to the supervisor.
  • Answered constant flow of customer calls with minimal wait times. And customer telephone calls promptly to avoid on-hold wait times.
  • Updated account information to maintain customer records.
  • Maintained customer satisfaction with forward-thinking strategies
  • Focused on addressing customer needs and resolving concerns.

Education

Bachelor of Arts - Organizational Leadership

Arizona State University
05.2022

Associate of Arts - Fine Arts

Northwest Vista College
05.2020

High School Diploma - undefined

Taft High School
06.2018

Skills

  • Claim processing
  • Benefit administration
  • Customer service
  • Microsoft office suite
  • Organizational skills
  • Insurance knowledge
  • Time management
  • Analytical skills
  • Medical terminology
  • Data entry proficiency
  • Empathy and compassion

Timeline

Claims Processor

CVS Health
05.2020 - Current

Claim Specialist

Anthem
10.2017 - 04.2020

Team Lead

Jason Deli
08.2016 - 10.2017

Customer Service Representative

Seaworld Parks & Resorts
05.2014 - 08.2016

Associate of Arts - Fine Arts

Northwest Vista College

High School Diploma - undefined

Taft High School

Bachelor of Arts - Organizational Leadership

Arizona State University

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