LaShonda Curry
Fort Worth,TX
Summary
Looking for a position where I can use my skills and knowledge to be a contribution to the growth of the company.
Highly professional individual with over 20 years in the Health Insurance Industry; starting from Customer Service Representative, Claims Analyst to Claims Supervisor.
Overview
30
30
years of professional experience
Work History
Claims Examiner III
Globe Life
12.2017 - Current
- Handled sensitive information with discretion, ensuring confidentiality of personal and financial details for claimants throughout the claims examination process.
- Utilized analytical skills to evaluate medical bills for accuracy and appropriateness of charges before approving payments as part of the claims process.
- Provided exceptional customer service by empathetically addressing claimants'' concerns and effectively explaining the claims process to them.
- Managed caseloads effectively while maintaining high-quality work standards and meeting strict deadlines consistently.
- Read over insurance policies to ascertain levels of coverage and determine whether claims would receive approvals or denials.
- Conducted day-to-day administrative tasks to maintain information files and process paperwork.
Claims Supervisor
American Specialty Health
09.2015 - 03.2017
- Established and checked coding procedures, monitored reports and updated internal files.
- Prepared cash flow projections, cost analysis and monthly, quarterly and annual reports.
- Established internal audit procedures to validate and improve accuracy of financial reporting.
- Implemented and regularly reviewed financial controls to generate accurate and reliable financial data.
- Self-motivated, with a strong sense of personal responsibility.
- Worked effectively in fast-paced environments.
- Excellent communication skills, both verbal and written.
- Worked well in a team setting, providing support and guidance.
- Assisted with day-to-day operations, working efficiently and productively with all team members.
- Passionate about learning and committed to continual improvement.
Claims Supervisor
Hammer & Gainer Inc
01.2012 - 09.2015
- Prepares daily, weekly and monthly claim reports such as Backlog/Aging Reports
- Review quality of claims processing
- Oversee the handling of DOI'S (Department of Insurance Complaints) & BBB's (Better Business Bureau) responses
- Review weekly check preview for approval
- Review all Appeals and Attorney Letters
- Managed accuracy and production targets set for the Claims Department
- Various training class on HIPPA and Fraudulent Claim Handling
- Strong background in pre-existing investigation
- Review payment on all high dollar claims
- Maintain knowledge of all claims administration and state guidelines
- Handled complex complaints
- Process Fully & Self Funded Accounts, Dental, STD (Short Term Disability) and Occupational Accident Claims
- Track/trend deficiencies found during the auditing process and provide any necessary re-education to improve quality
Sr Claims Analyst
CBCA Insurance Company
02.2010 - 12.2011
- Supported team efficiency efforts by developing standardized templates for common claim types, expediting document preparation timeframes.
- Collaborated with legal counsel to successfully negotiate favorable settlements for disputed claims cases.
- Improved customer satisfaction by consistently resolving complex claims in a timely and professional manner.
- Served as a subject matter expert on complex claim cases, offering consultation and guidance to colleagues in need of assistance.
Sr Claims Examiner
Kaiser Permanente
02.2007 - 12.2009
- Conducted day-to-day administrative tasks to maintain payments (accounts receivable). Maintain monthly spreadsheet sheet and balance payment register.
Claims Examiner
ATI Temp Agency
01.1999 - 12.2000
- Provided exceptional customer service, addressing concerns from policyholders and answering inquiries related to their claims status.
- Collaborated with healthcare providers to obtain necessary medical records, ensuring timely and accurate claim adjudication.
- Implemented quality control measures to detect potential issues early on, preventing costly mistakes or delays in payment processing timeframes.
Claims Examiner
AEGON USA
01.1995 - 12.1998
- Process claims efficiency by conducting thorough investigations and maintaining accurate documentation.
- Provided exceptional customer service, addressing concerns from policyholders and answering inquiries related to their claims status.
- Maintained compliance with industry regulations and company policies while evaluating medical claims for accuracy and legitimacy.
- Maintained knowledge of benefits claim processing, claims principles, medical terminology, and procedures and HIPAA regulations.
Education
Associate of Science - Business Management
Southern New Hampshire University
New Hampton, NH10-2022
Graduate -
Paul Laurence Dunbar
Fort Worth, TX05-1987
Skills
- AS400
- RYMS
- QuickClaims
- AcceleHealth
- Claimscape-Data Genix
- Microsoft Word
- Microsoft Excel
- Spreadsheets
- Verbal communication
- Claims processing
- Decision-making skills
- Organizational skills
- Excellent communication
- Multitasking Abilities
- Time management
- Insurance policy knowledge
- Customer service
- Problem-solving
- Attention to detail
- Problem-solving abilities
Timeline
Claims Examiner III
Globe Life
12.2017 - Current
Claims Supervisor
American Specialty Health
09.2015 - 03.2017
Claims Supervisor
Hammer & Gainer Inc
01.2012 - 09.2015
Sr Claims Analyst
CBCA Insurance Company
02.2010 - 12.2011
Sr Claims Examiner
Kaiser Permanente
02.2007 - 12.2009
Claims Examiner
ATI Temp Agency
01.1999 - 12.2000
Claims Examiner
AEGON USA
01.1995 - 12.1998
Associate of Science - Business Management
Southern New Hampshire University
Graduate -
Paul Laurence Dunbar
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