Kiara Runnels
Porter,TX
Summary
Organized and dependable candidate successful at managing multiple priorities with a positive attitude. Willingness to take on added responsibilities to meet team goals.
Overview
5
5
years of professional experience
Work History
Medical Claims Processor
CVS
Remote
12.2024 - Current
- Manage 80–120+ inbound calls daily regarding medical claims, billing inquiries, and insurance coverage questions. Review and explain claim status, payment details, denials, and processing timelines to members and providers.
- Investigate claim discrepancies by reviewing EOBs, payer portals, and internal systems. Submit claim corrections, reconsiderations, and escalation requests when required.
- Verify insurance eligibility, benefits, and coverage limitations. Document all interactions accurately in claims and CRM systems.
- Coordinate with insurance carriers, billing departments, and provider offices to resolve claims issues. Maintain strict adherence to HIPAA and company compliance policies.
Medical Insurance Specialist
Walgreens
Remote
12.2023 - 12.2024
- Handle high volumes of inbound calls from patients, providers, and insurance carriers regarding medical claims, benefits, and billing questions.
- Verify patient insurance eligibility, plan coverage, and benefits for outpatient, inpatient, and specialist services. Review and resolve denied or pending claims through research and coordination with insurance companies.
- Explain coverage details, copays, deductibles, and out-of-pocket expenses in clear, patient-friendly terms. Process and track prior authorization requests for medications, procedures, and treatments.
- Collaborate with providers, billing departments, and insurance adjusters to expedite claim resolution
Patient Account Representative
Iqor
Remote
06.2021 - 12.2023
- Respond to a high volume of inbound calls from patients and providers regarding Medicare billing, claims, and payment inquiries.
- Research and resolve complex account issues including denied claims, payment posting discrepancies, and prior authorizations.
- Educate patients on billing statements, balances, and Medicare coverage options while maintaining empathy and professionalism.
- Collaborate with billing, claims, and provider relations teams to expedite resolution of patient concerns. Accurately verify Medicare and supplemental insurance coverage using payer portals and internal systems.
Education
Associate of Applied Science - Animal Health
Lone Star College
Houston, TXSkills
- Remote Operations
- Eligibility determination
- Call Center Quality Metrics
- Email Support
- Claim denial resolution
- Critical Decision-making
- Medicare expertise
- Claims processing
- Exceeding Customer Expectations
- Chat Support
- Data Entry
- Empathy and patience
- Electronic medical records
- Insurance verification
- Prior authorization process
- Insurance Verification & Eligibility
- Claims Processing & Resolution
- EOB and Account Reconciliation
- High-Volume Inbound/Outbound Calls
- Data Entry & Documentation Accuracy
Timeline
Medical Claims Processor
CVS
12.2024 - Current
Medical Insurance Specialist
Walgreens
12.2023 - 12.2024
Patient Account Representative
Iqor
06.2021 - 12.2023
Associate of Applied Science - Animal Health
Lone Star College