Middy McClure
Anderson ,SC
Summary
Dynamic Claims Representative with a proven track record at Self Employed Services, excelling in claims processing and customer service. Leveraging strong analytical skills and attention to detail, I streamlined workflows, reducing claim resolution times significantly. Adept at fostering client relationships, I ensured compliance while enhancing overall satisfaction through effective communication and problem-solving.
Overview
39
39
years of professional experience
1
1
Certification
Work History
Claims Representative
Self Employed Services
Anderson SC
01.2012 - Current
- Processed insurance claims efficiently, ensuring compliance with company policies and regulations.
- Assisted clients in understanding policy terms and claim processes, enhancing customer satisfaction.
- Evaluated claim submissions for accuracy, identifying discrepancies to facilitate resolution.
- Coordinated with external vendors to gather necessary documentation for claim processing.
- Maintained detailed records of all claims activities using industry-standard software systems.
- Maintained compliance with industry regulations by adhering to established procedures and guidelines in claims handling.
- Developed strong relationships with clients, facilitating trust and open communication during the claims process.
- Enhanced claim processing efficiency by streamlining workflows and implementing best practices.
- Conducted detailed assessments of claims documents, ensuring accuracy and completeness before submission for approval.
- Reduced turnaround time for claim settlements by prioritizing tasks and managing deadlines effectively.
- Served as a subject matter expert on specialized claims, providing guidance and support to other team members when needed.
- Provided exceptional customer service, addressing concerns and resolving issues promptly.
- Developed in-depth understanding of insurance policies and procedures.
- Investigated and resolved complex claims, ensuring adherence to policy guidelines and regulatory compliance.
- Coordinated with healthcare providers to verify treatment plans and expenses.
- Analyzed claim trends to anticipate potential issues and proactively adjust processing strategies.
- Maintained up-to-date knowledge of regulatory changes, ensuring company compliance and minimizing legal risks.
- Streamlined interdepartmental communication, facilitating faster claim processing.
- Achieved high levels of accuracy in claim assessment, minimizing company's exposure to risk.
- Reduced claim resolution times with thorough documentation and timely follow-up.
- Enhanced client satisfaction by efficiently processing claims within designated time frames.
- Verified client information by analyzing existing evidence on file.
- Prepared insurance claim forms or related documents and reviewed for completeness.
- Resubmitted claims after editing or denial to achieve financial targets and reduce outstanding debt.
- Maintained confidentiality of patient finances, records, and health statuses.
- Carried out administrative tasks by communicating with clients, distributing mail, and scanning documents.
- Maintained strong knowledge of basic medical terminology to better understand services and procedures.
Licensed Dispensing Optician
Price&Wood Opticians, LensCrafters, Self Employed
Atlanta, GA & Anderson, SC
01.1987 - 01.2017
- Dispensed eyewear prescriptions accurately, ensuring patient satisfaction.
- Assessed patients' visual needs through comprehensive eye examinations.
- Provided education on lens options and proper eyewear care.
- Managed inventory of frames and lenses to optimize product availability.
- Developed personalized fitting techniques to enhance comfort and style.
- Collaborated with healthcare professionals to ensure seamless patient referrals.
- Trained new staff on dispensing procedures and customer service standards.
- Implemented best practices for operational efficiency in daily workflows.
- Resolved customer complaints efficiently, demonstrating empathy and understanding while maintaining professionalism at all times.
- Educated patients on proper eyewear care techniques, prolonging the lifespan of their glasses or contact lenses.
- Collaborated with optometrists to ensure seamless patient care and support as needed.
- Demonstrated versatility by cross-training in various roles within the practice, contributing to a cohesive team environment.
- Exceeded monthly sales targets consistently by employing effective upselling strategies and fostering rapport with clients.
- Utilized industry-specific software programs for efficient management of client records and appointment scheduling.
- Achieved high-quality results with meticulous attention to detail during lens fitting procedures.
- Assisted patients in selecting frames that met their aesthetic preferences and budget requirements.
- Increased sales revenue by effectively communicating lens technology benefits to customers.
- Conducted quality control checks on incoming shipments, verifying accuracy of prescription lenses to uphold high standards of care.
- Streamlined appointment scheduling processes to minimize wait times and enhance overall patient experience.
- Promoted eye health awareness among clients through informative conversations about preventative measures.
- Enhanced customer satisfaction by providing personalized eyewear recommendations and adjustments.
- Contributed to an increase in repeat business through exceptional customer service and follow-up aftercare appointments.
- Regularly attended continuing education seminars to stay current on industry trends and advancements in optical technology.
- Managed inventory levels, ordering new products as necessary to maintain optimal stock availability.
- Maintained a clean and organized optical dispensary, ensuring efficiency in daily operations.
- Performed comprehensive measurements for accurate eyewear prescriptions, ensuring optimal visual clarity for patients.
- Calibrated seg heights, vertex, and pupillary distance and pantoscopic tilt to customize eyeglass orders and create perfect fit.
- Filed claims with vision and medical insurance companies to garner payment for optical services.
- Educated patients on proper use, care and maintenance of eyeglasses and contact lenses.
- Aided patients in selection of flattering eyeglass frames appropriate for prescription and style preferences.
- Contacted patients when eyeglasses or contact lenses arrived in store and assisted with final fitting.
- Verified and updated patient records promptly to guarantee accurate prescription information.
- Maintained safe, clean and organized environment to increase patient comfort.
- Confirmed quality control standards were met for all eyewear and contact lenses.
Education
High School Diploma -
Chillicothe High School
Chillicothe, OHSkills
- Microsoft office
- Insurance claims review
- Claims investigation
- Time management
- Decision-making
- Data analysis
- Coverage assessments
- Documentation review
- Workers compensation
- File management
- Documentation research
- Claims processing
- Customer service
- Attention to detail
- Active listening
- Critical thinking
- Eligibility determination
- Documentation processing
- Records management
- Information verification
- Organizing and prioritizing work
- Data integrity
- Document control
- Patient contact
- Client interviews
- Medical terminology
- Account management
- Documentation skills
- Patient rapport
- Paperwork processing
- Composing business correspondence
Certification
LDO
NCLE
Timeline
Claims Representative
Self Employed Services
01.2012 - Current
Licensed Dispensing Optician
Price&Wood Opticians, LensCrafters, Self Employed
01.1987 - 01.2017
High School Diploma -
Chillicothe High School