NAMMARA DAVIS
Bay Shore
Summary
Dedicated and detail-oriented professional with over 3 years of experience in remote claims management and healthcare operations. Proven track record in accurately processing claims, ensuring compliance with industry regulations, and delivering exceptional customer service. Proficient in utilizing healthcare software and collaborating with cross-functional teams to optimize claims processes. Seeking a remote claims/healthcare position to contribute to the success of a progressive healthcare organization.
Overview
5
5
years of professional experience
Work History
Medical Claims Specialist
Cigna
04.2021 - 05.2023
- Processed an average of 40 claims per day, ensuring accuracy and adherence to company guidelines and industry regulations
- Utilized claims management software to track and monitor claims status, communicate with stakeholders, and generate reports for management analysis
- Demonstrated exceptional customer service skills by addressing claim-related inquiries and concerns, resulting in a 90% increase in customer satisfaction ratings
- Received commendations from team members and supervisors for consistently meeting or exceeding productivity and quality targets
Appeals and Grievances Coordinator
MOLINA HEALTHCARE
01.2020 - 02.2021
- Analyzed and resolved verbal and written claims, medical pre-service appeals, Part D pre-service appeals from both providers and members
- Analyzed and resolve verbal and written grievances and CTMs from members and legal representatives
- Took verbal grievance and appeals requests from Member Services and/or other departments and migrate to the organization's Appeals & Grievance system for tracking and processing
- Conduct outreach to members and providers for additional information required to resolve grievance and appeals cases
- This may involve placing outbound calls or sending faxes or e-mails
Senior Member Services Representative
WALGREENS
09.2018 - 12.2019
- Managed the pre-authorization process for medical procedures, ensuring timely approvals and minimizing patient wait times
- Developed and maintained effective relationships with insurance companies, negotiating favorable terms and maximizing reimbursement rates
- Conducted regular audits of medical records and billing documentation to ensure compliance with coding and billing guidelines
- Trained and mentored new staff members on claims processing procedures and compliance requirements
Education
MEDICAL ASSISTANT - Medical Assistant
NewYork Medical Training Center
Garden City, NY01.2024
Skills
- Customer Service Excellence
- De-Escalation Techniques
- Professional Telephone Demeanor
- Excellent Written and Verbal Communication
- Ability to Demonstrate Patience, Empathy and Compassion
- Ability to Navigate Through Multiple Systems
- Customer Data Confidentiality
- Strong Analytical and Problem Solving Skills
- Call Center Operations
- LiveChat Messaging
- Strong Time Management and Prioritization Skills
- Inbound and Outbound Calling
- Teamwork and Collaboration
- Customer Relationship Management (CRM)
- Appointment Scheduling
- Eligibility Determination
- Medical Billing
- Drug Inventory Control
- Drug Inventory Management
- Quality Assurance and Control
- Pharmacy Operations
- HIPAA Compliance
- Insurance Verification
- Strong Medical Terminology
- Prescription Filling
- Insurance Billing
- Grievance Management
Timeline
Medical Claims Specialist
Cigna
04.2021 - 05.2023
Appeals and Grievances Coordinator
MOLINA HEALTHCARE
01.2020 - 02.2021
Senior Member Services Representative
WALGREENS
09.2018 - 12.2019
MEDICAL ASSISTANT - Medical Assistant
NewYork Medical Training Center
Similar Profiles
Maura HilbertMaura Hilbert
Utilization Review/ Clinical Appeal RN at CignaUtilization Review/ Clinical Appeal RN at Cigna
Taya SharpeTaya Sharpe
Account Installation Specialist at CignaAccount Installation Specialist at Cigna
Jessica BranchJessica Branch
(Remote) Customer Service Supervisor at Cigna(Remote) Customer Service Supervisor at Cigna