Lora Smith
Summerville,GA
Summary
Seasoned Claims Benefit Insurance Specialist with excellent planning and problem solving abilities. Offering 2 years of experience and a willingness to take on any challenge. Organized, driven and adaptable professional with successful history managing high caseloads in fast-paced environments.
Overview
4
4
years of professional experience
Work History
Claims Benefit Specialist
Omni Interactions
Summerville, GA
11.2021 - 01.2024
- Adhered strictly to HIPAA guidelines when handling confidential patient information.
- Verified customer eligibility for specific benefits according to established criteria.
- Performed detailed analysis of claim data to identify trends or inaccuracies in the system.
- Reviewed and evaluated customer claims for accuracy, completeness and compliance with company policies.
- Maintained up-to-date knowledge of relevant laws, regulations, policies, and procedures related to benefit programs.
- Compiled data from various sources to assess benefit eligibility and entitlement.
- Documented claim processing activities in accordance with established procedures.
- Maintained knowledge of policies and procedures and insurance coverage benefit levels, eligibility systems and verification processes.
- Documented specific claims by completing and recording forms, reports and logs.
- Checked documentation for appropriate coding, catching errors and making revisions.
- Processed claims for payment or forwarded to appropriate personnel for further investigation
- Collaborated with fellow team members to manage large volume of claims.
- Called insurance companies to ascertain pertinent information regarding policies and payment benefits for patients.
- Handled billing related activities focused on medical specialties.
- Retained strong medical terminology understanding in effort to better comprehend procedures.
- Transcribed data to worksheets and entered data into computer to prepare documents and adjust accounts.
Call Center Representative
Omni Interactions
Summerville, GA
05.2020 - 10.2021
- Answered incoming calls and provided highest level of professionalism and knowledgeable service to every customer.
- Answered incoming calls from customers and provided assistance with product inquiries, billing questions, and other customer service related issues.
- Maintained high levels of professionalism while interacting with customers via phone or email.
- Answered, screened and processed high volume of calls daily with call management system and web-based communications.
- Updated customer accounts, addresses and contact information within call management databases.
- Resolved customer inquiries, questions and concerns to consistently offer quality service and meet performance benchmarks.
- Resolved customer complaints in a timely manner to ensure customer satisfaction.
- Navigated through computer systems to review information and respond appropriately to callers.
- Maintained strong call control and quickly worked through scripts to address problems.
- Engaged actively with callers, confirming or clarifying information and diffusing anger.
- Met or exceeded call speed, accuracy and volume benchmarks on consistent basis.
- Offered resolutions to de-escalate calls and solve customer issues.
- Maintained records of customer interactions, transactions, comments, and complaints.
- Managed customer expectations by clarifying needs, identifying options and recommending products and services.
- Delivered fast, friendly and knowledgeable service for routine questions and service complaints.
- Utilized knowledge base to answer inquiries from customers quickly and effectively.
- Followed standard processes and procedures for proper escalation of unresolved issues to appropriate internal teams.
- Asked probing questions to determine service needs and accurately input information into electronic systems.
- Assisted customers with navigating the company's website to locate desired information or items for purchase.
- Attended regular training sessions on updates and changes within the industry or organization.
- Adhered strictly to all applicable laws and regulations pertaining to customer privacy rights.
- Developed effective working relationships with team members across multiple departments.
- Promoted high customer satisfaction by resolving problems with knowledgeable and friendly service.
- Engaged in conversation with customers to understand needs, resolve issues and answer product questions.
- Kept records of customer interactions or transactions, thoroughly recording details of inquiries.
- Utilized job-related software to prepare change of address records and issue service discontinuance orders.
- Improved product knowledge on continuous basis to provide optimal service.
Education
GED -
Front Range Community College
Westminster, CO08-2006
Skills
- Documentation Review
- Verbal Communication
- Insurance Knowledge
- Claims Investigation
- Claims Processing
- Data Entry
- Teamwork and Collaboration
- Customer Service
- Written Communication
- Understanding of Medical Terms
- Exceptional Recordkeeping Abilities
- Secure Data Practices
- Continuous Improvement
- Data Entry Software
- Insurance Terminology
- Critical Thinking
- Team Building
- Problem-Solving Abilities
- Reliability
- Medical Terminology
- Insurance Coverage Verification
- Decision-Making
- Multitasking
- Interpersonal Skills
- Team Collaboration
- Organizing and Prioritizing Work
- Medicaid Knowledge
- Time Management Abilities
- Goal Setting
- Active Listening
- Data Transcription
- Time Management
- Attention to Detail
- Excellent Communication
- Organizational Skills
- Insurance Plan Verification
- Patient Rapport
- Data Integrity
- Task Prioritization
- Problem-Solving
- Professionalism
- Effective Communication
- Relationship Building
- Self Motivation
- Document Control
Custom
I am a mom to 6 children. I am a dedicated and hardworking person that puts others before myself. Before working for Omni Interactions I was a stay at home mom for 11 years. I am very organized and a self starter. I have great customer service skills and will be a great addition to your company.
Timeline
Claims Benefit Specialist
Omni Interactions
11.2021 - 01.2024
Call Center Representative
Omni Interactions
05.2020 - 10.2021
GED -
Front Range Community College