Laneishia Joyner
Brandon,FL
Summary
Tactful Claims Specialist with expertise in settlement preparation, claims processing and appeal filing. Diplomatic and personable professional accustomed to handling sensitive, confidential information and investigating complex liability claims. Committed to maintaining customer satisfaction and contributing to company success.
Overview
9
9
years of professional experience
Work History
Claims Customer Service Representative
Cigna Healthcare
06.2022 - Current
- Assessed customer needs and recommended suitable insurance policies.
- Fielded customer complaints, escalating complex issues to management for resolution.
- Advised customers on required information for claim submissions to progress applications.
- Provided primary customer support to internal and external customers.
- Answered incoming phone calls to articulate product value to prospective customers and support current policyholders.
Claims Research and Resolution Specialist 2
Humana
01.2015 - 04.2022
- Verified patient insurance coverage and benefits for medical claims.
- Managed large volume of medical claims on daily basis.
- Maintained knowledge of benefits claim processing, claims principles, medical terminology, and procedures and HIPAA regulations.
- Paid or denied medical claims based upon established claims processing criteria.
- Researched and resolved complex medical claims issues to support timely processing.
- Monitored and updated claims status in claims processing system.
- Processed insurance payments and maintained accurate documentation of payments.
- Maintained strong knowledge of basic medical terminology to better understand services and procedures.
- Processed adjustments and posted refunds.
Education
High School Diploma -
Blake High School
Tampa, FL05.2002
Skills
- Production Goals
- Customer Satisfaction
- Microsoft Office
- Project Requirements
- Settlement Management
- Exceptional Recordkeeping Abilities
- Great Mathematical Skills
- Insurance Industry Experience
- Documentation Review
Timeline
Claims Customer Service Representative
Cigna Healthcare
06.2022 - Current
Claims Research and Resolution Specialist 2
Humana
01.2015 - 04.2022
High School Diploma -
Blake High School
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