Na'China Wesley
Philadelphia,PA
Summary
Analytical problem-solver with excellent communication skills. Effective at interviewing claimants, compiling records and documenting findings. Well-versed in insurance policies, practices and standards.
Overview
7
7
years of professional experience
Work History
Participant Claims Representative
AmeriHealth Caritas
11.2021 - Current
- Processed and adjudicated participant claims accurately and efficiently, ensuring compliance with plan provisions, company policies, and regulatory guidelines.
- Reviewed and analyzed participant claim submissions, verifying eligibility, coverage, and supporting documentation to determine claim validity and appropriate reimbursement.
- Maintained detailed and organized claim records, utilizing claims management systems or databases to document claim activities, correspondence, and decision-making processes.
- Kept up with changes in healthcare regulations, coding guidelines, and industry best practices, continuously updating knowledge to ensure compliance and provide accurate claims processing.
Member Outreach Specialist
New York Health And Hospials
06.2020 - 11.2021
- Successfully engaged with existing members through various communication channels, including phone calls, emails, and live chat, to provide exceptional customer service and address inquiries or concerns.
- Utilized active listening skills to understand member needs and tailor outreach efforts to provide personalized solutions, ultimately fostering strong member relationships and loyalty.
- Collaborated with cross-functional teams to resolve member issues, coordinating with internal departments such as billing, technical support, and account management to deliver prompt resolutions.
- Maintained accurate and up-to-date member records in the CRM system, ensuring all interactions are properly documented for future reference and follow-up.
Lead Cashier
Foot Locker
04.2018 - 08.2020
- Processed payments effectively and accurately handled cash, credit, debit and personal check transactions.
- Performed store opening, closing, and shift-change actions and kept accurate shift-change logs.
- Processed both cash and card purchases and returns.
- Trained, mentored, and developed new cashiers with positive and encouraging techniques to maximize performance and team contributions.
Crew Member
Trader Joe's
12.2016 - 04.2018
- Provided excellent customer service by greeting customers and meeting quality expectations.
- Assisted other team members to achieve goals.
- Trained new team members on procedures, customer service, and sales techniques.
- Addressed guest needs, questions, or concerns to create optimum experience onboard.
Education
High School Diploma -
New Design High School
New York, NY06.2016
Skills
- Microsoft Outlook
- Documentation Research
- Claims Preparation
- Microsoft Excel
- Microsoft Office
- Organization and Time Management
- Analytical Skills
- Teamwork and Collaboration
- HIPAA
Timeline
Participant Claims Representative
AmeriHealth Caritas
11.2021 - Current
Member Outreach Specialist
New York Health And Hospials
06.2020 - 11.2021
Lead Cashier
Foot Locker
04.2018 - 08.2020
Crew Member
Trader Joe's
12.2016 - 04.2018
High School Diploma -
New Design High School
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