KALEIGHA Lewis
Atlanta,GA
Summary
Effective Medical Claims Processor with strong background building rapport with providers to discuss claim status or claim denials. Driven performer equipped to handle multiple administrative tasks effectively. Exemplary worker with highly investigative skills when processing claims.
Proactive and goal-oriented professional with excellent time management and problem-solving skills. Known for reliability and adaptability, with swift capacity to learn and apply new skills. Committed to leveraging these qualities to drive team success and contribute to organizational growth.
Overview
8
8
years of professional experience
Work History
Medical Claims Processor Remote
Blue Cross Blue Shield
Columbia, SC
01.2025 - Current
- Conducted thorough research and processed claims to ensure adherence to regulatory requirements and processing guidelines.
- Achieved accurate coding of procedures and diagnoses, enhancing claim processing efficiency. Resolved edits, audits, and claim errors through diligent reference checks.
- Coordinated with internal teams to ensure timely updates of member provider and OHI files as required.
- Assisted with phone and written inquiries. Recorded information accurately for claim processing.
- Determine primacy and student dependent status; update claims/membership systems with appropriate information.
- Analyzed pending and rejected claims to facilitate appropriate adjustments, supporting efficient claims processing.
- Facilitated timely and accurate processing of specialized paper claims, ensuring adherence to provider contract specifics.
- Serve as a mentor/resource for newer processors and cross-functional teams; meet production and quality standards.
- Process medical claims efficiently, ensuring compliance with regulatory guidelines and company policies.
- Review and analyze claims submissions for accuracy, identifying discrepancies and resolving issues promptly.
Customer Service Representative
Call 4 Health
Remote
06.2022 - 12.2024
- Addressed inquiries and resolved complaints to enhance patient satisfaction and streamline communication.
- Executed appointment management processes, ensuring compliance with protocols and optimizing availability for providers.
- Managed billing inquiries to enhance customer satisfaction. Provided detailed explanations of charges, insurance coverage, and payment options. Investigated and rectified discrepancies to maintain accuracy.
- Ensured accuracy and compliance of patient records with HIPAA and confidentiality standards.
- Managed verification of insurance coverage, pre-authorization processes, and claims submission to ensure seamless operations.
- Facilitated communication between patients and providers; relayed messages, results, and critical information.
- Supported patients with online portal access, account setup, navigation, and troubleshooting.
- Distributed satisfaction surveys and compiled feedback for quality improvement initiatives.
- Resolved customer inquiries efficiently through multi-channel communication methods.
- Facilitated effective call routing and escalation processes to improve customer service efficiency.
Remote Customer Service Rep (Contract)
Work From Home
Remote
01.2023 - 12.2023
- Delivered comprehensive support via phone and email to address billing orders and account inquiries.
- Provided expert assistance in resolving account access issues and coordinating service appointments.
- Documented customer interactions meticulously while striving for first-contact resolution of complaints.
- Resolved customer inquiries through effective communication and problem-solving techniques.
- Utilized CRM software to track and manage customer interactions and feedback.
- Improved response times by streamlining communication processes within the team.
Grocery Associate
Walmart
Atlanta, GA
08.2020 - 05.2021
- Stocked shelves, rotated inventory, and assisted customers in locating products.
- Supported front-end operations and operated registers during peak hours.
- Unloaded deliveries, organized stockrooms, and followed safety and cleanliness standards.
Warehouse Associate
Amazon Fulfillment Center
Atlanta, GA
05.2019 - 08.2020
- Scanned, sorted, and packed products to meet strict delivery timelines and accuracy targets.
- Used pallet jacks and material handling equipment to load/unload shipments safely.
- Followed safety procedures and maintained a clean, organized work area.
- Operated forklifts and pallet jacks to efficiently move products within fulfillment center.
- Received incoming shipments, verified product quality, and organized inventory for optimal accessibility.
- Prepared orders for shipment by accurately picking, packing, and labeling items per customer specifications.
- Conducted regular inventory counts to maintain accurate stock levels and reduce discrepancies.
Housekeeper (Traveling Staff)
Marriott Hotels (via Traveling Staff Agency)
Multi-state Travel
01.2018 - 05.2019
- Adapted quickly to new locations and teams to maintain consistency and quality.
- Developed comprehensive reports on inventory performance for senior management review.
- Led initiatives to implement advanced inventory control technologies, enhancing efficiency and accuracy.
- Enhanced inventory accuracy by conducting regular cycle counts and reconciling discrepancies.
- Streamlined inventory processes, resulting in improved tracking and reduced waste.
- Conducted regular audits to identify discrepancies and maintain data integrity.
- Managed inventory levels, ensuring accuracy and timely replenishment of stock.
Education
Undergraduate Certificate - Medical Billing and Coding
DeVry University
02-2024
High School - undefined
Langston Hughes High School
Fairburn, GA05-2021
Beginner Spanish
Go Spanish Now
04-2019
Skills
- Teamwork and daily operations support with a professional, pleasant demeanor
- Leadership, team building, and problem-solving; mentor/peer resource
- Customer service and public relations; clear verbal communication and professional writing
- Phone etiquette, message taking, scheduling callbacks; tactful handling of inquiries
- Proficient in Microsoft Outlook, Excel, Word, PowerPoint, and Publisher
- Critical Decision-making
- ICD-10-cM coding
- Customer service
- Claim denial resolution
Accomplishments
- Used Microsoft Excel to develop inventory tracking spreadsheets.
COMMUNITY SERVICE
- ENACTUS, Member, participant, and volunteer, 2020-01, 2020-12
- Relay for Life, Atlanta, GA
- Boys & Girls Clubs of America, Chaperone
- Ora Lee West, Fundraising volunteer
- Holiday volunteer events, Food, clothing, and shelter support for displaced community members
SUMMARY OF QUALIFICATIONS
- Trained and motivated new employees in compliance, safety, and standard procedures.
- Assisted with weekly scheduling; balanced hours, absences, and time-off needs.
- Resolved customer inquiries and complaints promptly across in-person, online, and phone channels.
- Handled inventory: loading/unloading deliveries; documented counts and quality; able to lift 50 lbs.
- Opened/closed facilities; cash handling; ensured sanitation and proper disposal procedures.
Languages
Spanish
Limited Working
Timeline
Medical Claims Processor Remote
Blue Cross Blue Shield
01.2025 - Current
Remote Customer Service Rep (Contract)
Work From Home
01.2023 - 12.2023
Customer Service Representative
Call 4 Health
06.2022 - 12.2024
Grocery Associate
Walmart
08.2020 - 05.2021
Warehouse Associate
Amazon Fulfillment Center
05.2019 - 08.2020
Housekeeper (Traveling Staff)
Marriott Hotels (via Traveling Staff Agency)
01.2018 - 05.2019
High School - undefined
Langston Hughes High School
Beginner Spanish
Go Spanish Now
Undergraduate Certificate - Medical Billing and Coding
DeVry University