Melissa Cason
Laveen,AZ
Summary
To seek and maintain full-time position that offers professional challenges utilizing interpersonal skills, excellent time management and problem-solving skills.
Overview
16
16
years of professional experience
Work History
Claims Adjuster
Banner Desert Medical Center
07.2023 - Current
- Examined claims forms and other records to determine insurance coverage.
- Work with insurance companies to determine the cause of denial or non-payment of a claim
- Documented all investigation activity and presented reports to management.
- Verified insurance claims and determined fair amount for settlement.
- Researched and analyzed policy contracts to verify proper payment of claims.
- Conducted thorough investigations of complex insurance claims, gathering evidence and analyzing relevant documentation.
- Achieved cost savings through successful subrogation efforts, recovering funds from responsible parties in various claims scenarios.
- Prepared summaries of damage, payments, and policy coverage.
Claims Representative
Aurora St. Luke's Medical Center
02.2013 - 06.2022
- Followed up with customers on unresolved issues.
- Improved customer satisfaction by providing timely and accurate information on claim status and resolution.
- Analyzed and addressed escalated claims to resolve issues quickly.
- Investigated accidents or incidents to determine cause and extent of damages.
- Trained new Claims Representatives on company policies, procedures, and software systems, improving overall team productivity.
- Calculated adjustments, premiums and refunds.
- Resubmitted claims after editing or denial to achieve financial targets and reduce outstanding debt.
Customer Service Manager
DentaQuest
07.2008 - 02.2013
- Managed a team of customer service representatives, fostering a positive work environment focused on teamwork and collaboration.
- Trained and regularly mentored associates on performance-oriented strategies and customer service techniques.
- Reduced customer complaints, proactively addressing issues and implementing effective solutions.
- Followed through with client requests to resolve problems.
- Actively listened to customers, handled concerns quickly and escalated major issues to supervisor.
- Handled escalated calls efficiently from Medicare and Medicaid patients, finding satisfactory resolutions for both customers and the company alike.
- Conducted regular quality assurance checks on interactions with customers to ensure agents were meeting established guidelines and standards for service excellence.
Education
High School Diploma -
Kilmer South
Milwaukee, WI06.2004
Skills
- Claims Investigation
- Highly motivated
- Claims Processing
- Risk Assessment
- Quality Control
- Customer service and support
- Active Listening
- Claims
- Payment Processing
- Benefits review
Timeline
Claims Adjuster
Banner Desert Medical Center
07.2023 - Current
Claims Representative
Aurora St. Luke's Medical Center
02.2013 - 06.2022
Customer Service Manager
DentaQuest
07.2008 - 02.2013
High School Diploma -
Kilmer South