Monique Davis
Tampa
Summary
Knowledgeable, efficient and skilled Senior Claims Examiner with proven expertise in handling high-value and complex claims. Oversees work of junior staff to keep claims handling accurate and within guidelines. Well-versed in managing escalations, reserves and claims audits.
Overview
6
6
years of professional experience
Work History
Senior Claims Examiner
Wipro
Remote
01.2025 - Current
- Evaluated claims for accuracy and compliance with company policies.
- Utilized claims management software to document and track claim status.
- Facilitated training sessions for new team members to ensure adherence to best practices.
- Created process documentation to standardize team procedures and guidelines.
- Participated in meetings with senior management personnel to discuss policy changes related to claims adjudication.
Claims Examiner
Sagility Health
Remote
11.2023 - 12.2024
- Paid and processed claims while adhering to designated authority levels, ensuring timely and accurate payments.
- Reviewed claims to ensure accuracy and compliance with policy guidelines, minimizing errors in processing.
- Processed claims with claims management software, streamlining workflow and reducing processing time.
- Managed workloads efficiently by prioritizing tasks based on urgency or importance.
- Developed a detailed understanding of the company's policies and procedures related to claim processing and payment determination.
Key Holder Supervisor
Americas Best Contacts And Eyeglasses
Brandon
11.2019 - 04.2023
- Trained new staff on customer service protocols and optical terminology to ensure consistent service quality.
- Oversaw cash handling procedures while maintaining accurate financial records to support operational integrity.
- Assessed patient vision needs and recommended appropriate eyewear to enhance customer satisfaction.
- Entered patient data into electronic health record systems accurately.
Education
High School Diploma -
Spoto High School
Riverview05-2017
Skills
- Claims handling
- Claims evaluation
- Claims management software
- Medical terminology
- ICD coding
- ICD-10
- Billing codes
- Electronic claims
- CMS-1500 billing
- Medicare processes
- HIPAA compliance
- Process documentation
- QNXT experience
- ACAS experience
Timeline
Senior Claims Examiner
Wipro
01.2025 - Current
Claims Examiner
Sagility Health
11.2023 - 12.2024
Key Holder Supervisor
Americas Best Contacts And Eyeglasses
11.2019 - 04.2023
High School Diploma -
Spoto High School