Detail-oriented Claim Specialist driven to resolve claims fairly while representing interests of employer. Conducts thorough and informed investigations, precisely evaluates losses and negotiates settlements that satisfy diverse parties. Builds and maintains professional and productive relationships and works to understand potentially conflicting points of view.
Hi, I’m
Olivia Darling
Claim Specialist
Cordova,TN
Summary
Overview
7
years of professional experience
Work History
BroadPath Healthcare, AZ
Pharmacy Technician Specialist
10.2022 - 04.2023
Job overview
- Transmitted claims to insurance companies for payment and reconciled EOBs.
- Flagged potential side effects and allergies to prescribed medications for patients.
- Prepared and processed medical insurance claim forms and records.
- Investigated questionable claims to determine payment authorization.
- Requested scripts from doctors, verified insurance, coding and much more.
CVS Caremark
Claims Specialist
07.2021 - 09.2022
Job overview
- Research and document clinical aspects of case and reasoning for coverage determination outcome in multiple databases.
- Maintained knowledge of policies and procedures and insurance coverage benefit levels, eligibility systems and verification processes.
- Resolved claims by approving or denying documentation, calculating benefits due, determining compensation settlement and much more.
WellCare
Appeals Specialist
01.2019 - 07.2021
Job overview
- Checked documentation for appropriate coding, catching errors and making revisions.
- Identified reasons behind denied claims and worked closely with insurance carriers to promote resolutions.
- Monitored reports to identify claims issues and worked with adjusters to resolve problems.
- Processed claims for payment or forwarded to appropriate personnel for further investigation and much more.
Education
Brookline College - PhoenixPhoenix, AZ
Some College (No Degree) from Business Administration And Management
University Overview
Due to COVID in 2020 school closed and became an inactive student.
Skills
- Pharmacy Operations
- Verifying Orders
- Customer Service
- Payment Processing
- Verbal and Written Communication
- Medication Documentation
- Data Entry
- Detail-Oriented
- Resolving Customer Issues
- Insurance Billing
- Insurance Verification
- Problem-Solving Skills
Timeline
Pharmacy Technician Specialist
BroadPath Healthcare
10.2022 - 04.2023
Claims Specialist
CVS Caremark
07.2021 - 09.2022
Appeals Specialist
WellCare
01.2019 - 07.2021
Brookline College - Phoenix
Some College (No Degree) from Business Administration And Management
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