Kaniyah Gamble
Fayetteville,NC
Summary
Results-driven professional with a background in data entry, prior authorization, and claims processing, bringing strong attention to detail and accuracy in high-volume settings. Experienced in reviewing and updating records, coordinating insurance approvals, and resolving claim issues to support smooth operations. Demonstrates strong organizational and communication skills, with the ability to multitask, meet deadlines, and maintain compliance with policies and confidentiality standards.
Overview
4
4
years of professional experience
Work History
Data Entry Analyst
Encoura
05.2024 - 04.2026
- Conducted data entry with high accuracy to maintain database integrity.
- Processed and validated large datasets, ensuring adherence to quality standards.
- Assisted in developing data management solutions to streamline workflows.
- Collaborated with team members to identify and resolve data discrepancies.
- Utilized Excel and SQL for data analysis and reporting tasks.
- Maintained confidentiality of sensitive information while handling data entries.
- Participated in training sessions to enhance skills in data management tools and techniques.
- Performed thorough audits of existing databases to identify discrepancies and rectify inaccuracies as necessary.
- Enhanced data accuracy by meticulously verifying and validating information entered into the system.
- Scanned documents and saved in database to keep records of essential organizational information.
Claims Specialist
Cigna
05.2022 - 02.2026
- Analyzed claims data to ensure compliance with company policies and regulatory requirements.
- Processed claims efficiently, resolving discrepancies and ensuring timely payments to policyholders.
- Collaborated with cross-functional teams to improve claims processing workflows and enhance customer satisfaction.
- Conducted thorough investigations of complex claims to identify fraudulent activities and mitigate risks.
- Managed a high volume of claims effectively by prioritizing tasks and maintaining excellent organizational skills.
- Reduced claim processing errors by conducting thorough investigations and accurately interpreting policy details.
- Identified fraudulent claims through diligent investigation and collaboration with law enforcement agencies when necessary.
- Improved claim processing efficiency by streamlining workflows and implementing time-saving strategies.
Prior Authorization Specialist
ResultsCx
Lakeland, FL
02.2022 - 04.2024
- Processed prior authorization requests efficiently, ensuring compliance with insurance policies.
- Communicated with healthcare providers to gather necessary documentation for approvals.
- Reviewed patient records to verify eligibility and necessity of services requested.
- Maintained accurate records of authorization requests in electronic systems.
- Monitored turnaround times for authorizations, identifying areas for improvement in service delivery.
- Analyzed medical records and other documents to determine approval of requests for authorization.
- Verified eligibility and compliance with authorization requirements for service providers.
- Reached out to insurance carriers to obtain prior authorization for testing and procedures.
- Responded to inquiries from healthcare providers regarding prior authorization requests.
Education
Bachelor of Arts - Psychology
Winston-Salem State University
Winston-Salem, NC12.2023
Skills
- Microsoft Excel
- Accuracy and precision
- Software knowledge
- Typing speed
- Data validation
- Confidentiality
- Data entry
- Administrative support
- Quality control
- Log book maintenance
- Technical support
- Microsoft office
- Document management and storage
- Task prioritization
Timeline
Data Entry Analyst
Encoura
05.2024 - 04.2026
Claims Specialist
Cigna
05.2022 - 02.2026
Prior Authorization Specialist
ResultsCx
02.2022 - 04.2024
Bachelor of Arts - Psychology
Winston-Salem State University