Monica Harrison
Stafford,VA
Summary
Hardworking and detail-oriented individual with fast typing speed. Friendly insurance professional experienced in investigating and processing insurance claims. Hardworking and communicative individual excels at interpreting policies and negotiating payment solutions. Recognized for providing optimum service to policyholders and quickly identifying fraudulent claims.
Overview
7
7
years of professional experience
1
1
Certification
Work History
Claims Specialist
Concentrix
11.2023 - 05.2024
- I Documented specific claims by completing and recording forms, reports, logs, and records in Excel spreadsheets
- Analyzed insurance claims to prevent fraud
- Prepared reports by collecting, analyzing, and summarizing information
- Resolved claims by approving or denying documentation, calculating benefits due, and determining compensation settlement
- Ensured legal compliance by following company policies, procedures, and guidelines, as well as state and federal insurance regulations
- Maintained quality customer service by following customer services practices and responding to customer inquiries
- Protected operations by keeping claims information confidential
- Maintains a good relationship with insurance departments.
Eligibility Specialist
AMA Consulting Group, LLC
03.2023 - 08.2023
- I process applications for clients in need of rental assistance
- I do a quality review on denials and appeals submitted to determine if they are correct or if they need to be sent back to agents for further processing
- I utilize data entry skills to complete service tickets done after outbounds calls
- I provide customer service to clients who are facing eviction or homelessness
- I conduct searches in the company database for documentation submitted by tenants and send email correspondence or place outbound calls to request needed documents to process applications such as a lease or income documentation.
Member Resource Specialist/Tech support
ACD Direct
05.2022 - 02.2023
- Research, translate, and update demographic data into the company data base
- Resolve member issues from daily resource requests and determine appropriate resolution action
- Solve and address member and potential member inquiries via email and chat
- Follow up with customers to ensure their technical issues are resolved
- Entering customer and account data from source documents within time limits
- Compiling, verifying accuracy and sorting information to prepare source data for computer entry
- Reviewing data for deficiencies or errors, correcting any incompatibilities and checking output
- Escalate applications to appropriate dept
- For review of required documents or for escalation of applications that meet the guidelines for time sensitive cases
- Provide detailed information about what programs Wounded Warrior Project offers
- Respond to customer queries in a timely and accurate way, via phone, email or chat
- Identify customer needs and help customers use specific features
- Analyze and report potential scams immediately
- Update our internal databases with information about technical issues and useful discussions with customers
- Enter customer data into companies internal data base such as demographics and payment information
- Monitor customer complaints and reach out to provide assistance
- Share feature requests and effective workarounds with team members
- Inform customers about new features and functionalities
- Follow up with customers to ensure their technical issues are resolved
- Gather customer feedback and share with our Product, Sales and Marketing teams.
Pharmacy Coordinator
Cardinal Health
10.2020 - 02.2022
- The MTM Pharmacy Patient Engagement Coordinator assists pharmacists in providing outstanding patient care and customer service while scheduling medication reviews
- In this role you Contact patients to introduce and explain the benefits of the MTM program
- Schedule appointments for the MTM Pharmacist(s) to complete Comprehensive Medication Reviews, Disease State Medication Reviews, or Targeted Interventions
- Provide exemplary internal and external customer service through prompt, professional, and polite communication
- Perform auxiliary functions essential to the efficient operation of the department
- Meet productivity and performance expectations set forth by manager
- Perform data entry into internal data base and Microsoft Excel spreadsheets.
Member Services Representative
BroadPath Healthcare Solutions
09.2017 - 03.2020
- I address member inquiries, questions and concerns in all areas including enrollment, claims, benefit interpretation, and referrals/authorizations for medical care
- Responsible for receiving, responding to, and directing member phone calls, or written questions
- I also provide available information upon request and researches or escalates issues as appropriate as well as Maintain confidentiality per HIPAA guidelines
- I performed light data entry in order to create member accounts and update member demographics and payment information
- I processed monthly premium payments as well as provide resources for financial aid
- I researched medical claims and followed up with Doctors and their staff to address issues that were found and escalate tickets for corrections if needed
- I scheduled Doctor appointments for members.
Education
Diploma - Medical Administrative Assistant
Valley college
Beckley, WV09.2014
Skills
- Customer Service
- Call Center
- Customer Care
- CSR
- Customer Support
- HIPAA
- Insurance Verification
- Live chat
- Medical scheduling
- Cold calling
- Technical support
- Data entry
- Medical Billing
- Medical Coding
Certification
- Medical Administrative Assistant, 09/01/14, Present
- Driver's license
Additional Information
Great customer service skills. Microsoft office sufficient. 40wpm
Timeline
Claims Specialist
Concentrix
11.2023 - 05.2024
Eligibility Specialist
AMA Consulting Group, LLC
03.2023 - 08.2023
Member Resource Specialist/Tech support
ACD Direct
05.2022 - 02.2023
Pharmacy Coordinator
Cardinal Health
10.2020 - 02.2022
Member Services Representative
BroadPath Healthcare Solutions
09.2017 - 03.2020
Diploma - Medical Administrative Assistant
Valley college