Lori Lemasters
Clarksburg,WV
Summary
Seasoned insurance specialist with excellent planning and problem solving abilities. Offering years of experience and a willingness to take on any challenge. Organized, driven and adaptable professional with successful history managing high caseload's for multiple facilities. Highly-motivated employee with desire to take on new challenges. Strong work ethic, adaptability, and exceptional interpersonal skills. Adept at working effectively unsupervised and quickly mastering new skills.
Overview
34
34
years of professional experience
Work History
Insurance Claims Specialist
WVU Medicine
Morgantown, West Virginia
10.2008 - Current
- Reviewed customer insurance claims to ensure accuracy and completeness of information.
- Analyzed claim records, policy provisions, and other relevant documents to determine validity of claims.
- Collaborated with fellow team members to manage large volume of claims.
- Collaborated with team members to identify trends in customer issues and develop solutions accordingly.
- Participated in training sessions conducted by insurers on new products and services.
- Reviewed denied claims for errors or omissions before finalizing decision notices.
- Processed requests for additional documentation from customers in a timely manner.
- Supported efficient handling of complex claims and followed up on open, denied, or suspended claims to complete required line items.
- Called insurance companies to ascertain pertinent information regarding policies and payment benefits for patients.
- Corresponded with insured or agent to obtain information or inform of account status or changes.
- Coordinated with external parties such as lawyers, surveyors, appraisers during investigations.
- Assist customers with status updates on claims.
- Resolved customer complaints related to insurance claim processing.
Customer Service Representative
United Hospital
Clarksburg
10.2006 - 10.2008
- Provided excellent customer service to resolve customer complaints in a timely manner.
- Promoted high customer satisfaction by resolving problems with knowledgeable and friendly service.
- Answered inbound calls, chats and emails to facilitate customer service.
- Remained calm and professional in stressful circumstances and effectively diffused tense situations.
- Developed strong relationships with customers by providing personalized assistance and support.
- Strengthened customer retention by offering discount options.
- Engaged in conversation with customers to understand needs, resolve issues and answer product questions.
- Performed administrative tasks such as filing paperwork, updating databases and generating reports.
- Resolved complex problems by working with other departments to provide solutions that meet customer needs.
- Answered customer inquiries via phone, email, and chat.
- Collected deposits or payments and arranged for billing.
Data Entry Clerk
United Hospital
Clarksburg
09.1995 - 10.2006
- Maintained confidentiality of sensitive information.
- Answered incoming phone calls and directed callers to appropriate departments and personnel.
- Scanned documents into appropriate databases for storage purposes.
- Prepared payroll documentation by entering data into cumulative payroll document.
- Organized and filed data in appropriate locations for easy access to essential information.
- Collaborated with other departments to resolve issues regarding incorrect data entries.
- Maintained confidentiality of sensitive information entered into the system.
- Performed data entry from paper documents, emails, and other sources into computer systems.
- Organized files according to established procedures for easy retrieval later on.
- Operated various office equipment such as scanners, printers. when required.
- Completed day-to-day duties accurately and efficiently.
ER Registration Clerk
United Hospital
Clarksburg
10.1990 - 10.1995
- Communicated with patients with compassion while keeping medical information private.
- Collaborated with multi-disciplinary staff to improve overall patient care and response times.
- Provided assistance to visitors and answered their questions regarding hospital services or directions within the facility.
- Worked collaboratively with medical staff to ensure accuracy in patient registrations.
- Verified insurance coverage and obtained authorizations as needed.
- Greeted patients and verified patient information for registration process.
- Arranged hospital admissions for patients as required.
- Filed appropriate documentation in accordance with established procedures.
- Maintained confidentiality of protected health information according HIPAA guidelines.
- Answered phone inquiries regarding hospital services, billing questions and other general information requests from patients or family members.
- Entered patient demographic and financial data into computer system accurately.
- Answered telephones and directed calls to appropriate medical or adminstrative staff.
- Adhered to HIPAA requirements to safeguard patient confidentiality.
- Accurately completed all necessary paperwork related to patient registration process such as forms, consent documents.
Education
Washington Irving High School
Clarksburg, WV05-1989
Skills
- Insurance Knowledge
- Insurance Claim Form Review
- Eligibility Determination
- Customer Service
- Teamwork and Collaboration
- Dispute Resolution
- Problem Solving
- Attention to Detail
- Professionalism
- Understand of Medical Terms
- Data Entry
- Patient contact
- Office equipment operation
- Reliability
- Multitasking Abilities
- Teamwork
Timeline
Insurance Claims Specialist
WVU Medicine
10.2008 - Current
Customer Service Representative
United Hospital
10.2006 - 10.2008
Data Entry Clerk
United Hospital
09.1995 - 10.2006
ER Registration Clerk
United Hospital
10.1990 - 10.1995
Washington Irving High School