Khaleiah Edwards
Houston
Summary
Diligent Claims Representative with solid background in processing and managing claims efficiently. Adept at assessing coverage and liability, and resolving complex claims issues. Proven ability to utilize strong analytical and communication skills to deliver exceptional service.
Overview
7
7
years of professional experience
Work History
Claims Representative
Sheakley Unicomp
07.2024 - Current
- Resolved complex insurance claims through comprehensive investigation and analysis of policy coverage.
- Collaborated with cross-functional teams to streamline claims processing and improve customer satisfaction.
- Conducted thorough reviews of claim files, ensuring accuracy and consistency in decision-making processes.
- Improved customer satisfaction by efficiently handling insurance claims and providing timely resolutions.
Intake and Claims Representative
Evicore HealthCare
09.2022 - 04.2024
- Work with social workers and healthcare professionals to develop treatment plans and insurance costs.
- Ensure all paperwork is properly completed and signed.
- Fax and email MD offices and facilities with corrected prior authorization information.
- Handle call volumes of 100+ calls daily including MD offices, patients, and healthplans.
- Gather Specific information whether it be in a legal or care environment.
- Create a positive and supportive environment for incoming members and callers.
- Handle first call resolutions, assuring the member or MD office issue is handled properly and correctly before ending the call.
- Evaluated and processed claims to ensure compliance with policies and regulations.
Tier 2 Customer Service Rep
Sutherland Global
05.2019 - 06.2022
- Send 50-100 Emails daily to customers once technical service issues are solved.
- Handles Customer inquiries and issues through various channels such as chat, email, and phone calls 20-30 times a day once I was able to solve the customers issue.
- Tier 1 and Tier2 duties along with assisting Tier 1 employees with questions.
- Maintaining customer accounts, records, and satisfaction.
- Identify and resolve customer problems, provide accurate information, and generate sales leads.
Education
High School Diploma -
Lone Star College
Houston, TX2030
High School Diploma -
Lone Star College
Houston, TX2030
Skills
- Claims investigation
- Time management
- Team collaboration
- Data analysis
- Decision-making
- Workers compensation
- Flexible schedule
Timeline
Claims Representative
Sheakley Unicomp
07.2024 - Current
Intake and Claims Representative
Evicore HealthCare
09.2022 - 04.2024
Tier 2 Customer Service Rep
Sutherland Global
05.2019 - 06.2022
High School Diploma -
Lone Star College
High School Diploma -
Lone Star College