Summary
Overview
Work History
Education
Skills
Certification
References
Timeline
Generic

OLIVIA THOMAS

Houston,TX

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. Qualified Claims Representative versed in investigating claims, verifying information and managing settlements. Friendly and upbeat team player with organized and disciplined approach. Offering 3 years of insurance experience. Experienced Insurance Specialist successful at managing high caseloads in fast-paced environments. Organized, driven and adaptable with excellent planning and problem-solving abilities. Offering 3 years of experience and willingness to take on any challenge. Gifted in working with stressed, confused and upset individuals in need of benefits information and supportive guidance to navigate systems. Effective at operating within Guidelines, regulations and department guidelines to manage telephone calls, emails, letters and in-person requests for assistance. Detail-oriented team player with strong organizational skills. Ability to handle multiple projects simultaneously with a high degree of accuracy. Qualified Claims Representative versed in investigating claims, verifying information and managing settlements. Friendly and upbeat team player with organized and disciplined approach. Offering 3 years of insurance experience. Highly trained professional with a background in verifying insurance benefits and creating appropriate patient documentation. An established Insurance Verification Specialist known for handling various office tasks with undeniable ease.

Overview

5
5
years of professional experience
1
1
Certification

Work History

Claims Representative

QUALITYS
08.2022 - 12.2023
  • Enhanced claim processing efficiency by streamlining workflows and implementing best practices.
  • Reduced turnaround time for claim settlements by prioritizing tasks and managing deadlines effectively.
  • Improved customer satisfaction by providing timely and accurate information on claim status and resolution.
  • Collaborated with cross-functional teams to expedite complex claims investigations and resolutions.
  • Negotiated favorable settlements with claimants, resulting in cost savings for the company.
  • Maintained compliance with industry regulations by adhering to established procedures and guidelines in claims handling.
  • Developed strong relationships with clients, facilitating trust and open communication during the claims process.
  • Conducted detailed assessments of claims documents, ensuring accuracy and completeness before submission for approval.
  • Provided exceptional customer service, addressing concerns and resolving issues promptly to maintain client satisfaction.
  • Assisted in updating company-wide claims manual, incorporating new regulatory requirements for more efficient processes.
  • Streamlined documentation processes through digitization efforts, reducing paperwork while maintaining data accuracy and security.
  • Facilitated prompt payment of approved claims by liaising with finance department to ensure smooth transaction processing.
  • Conducted thorough research on industry trends, enabling proactive adjustments to internal processes as needed for improved performance.
  • Communicated verification and authorization status updates with [Type] department to facilitate decision-making for patient admissions and insurance coverage.
  • Notified insurance agents and accounting departments of policy cancellations and changes.
  • Coordinated with contracting department to resolve payer issues.
  • Reviewed outstanding requests and redirected workloads to complete projects on time.
  • Processed and recorded new policies and claims.
  • Determined appropriateness of payers to protect organization and minimize risk.
  • Collected premiums and issued accurate receipts.
  • Communicated effectively with staff members of operations, finance and clinical departments.
  • Modified, updated and processed existing policies.
  • Posted payments to accounts and maintained records.
  • Calculated adjustments, premiums and refunds.
  • Checked documentation for accuracy and validity on updated systems.
  • Resubmitted claims after editing or denial to achieve financial targets and reduce outstanding debt.
  • Generated, posted and attached information to claim files.
  • Verified client information by analyzing existing evidence on file.
  • Maintained strong knowledge of basic medical terminology to better understand services and procedures.
  • Carried out administrative tasks by communicating with clients, distributing mail, and scanning documents.
  • Prepared and presented detailed reports to management on claims issues to aid in decision making.
  • Monitored and managed claim expenses to control costs and maximize profitability.
  • Developed and implemented strategies to improve claim processes.
  • Negotiated claim settlements with claimants and attorneys to resolve claims efficiently and fairly.
  • Examined reports, accounts, and evidence to determine integrity and accuracy of information.
  • Interviewed policyholders to verify information and obtain additional details.
  • Maintained accurate and up-to-date records of claim information for future reference.
  • Followed up with customers on unresolved issues.
  • Developed in-depth understanding of insurance policies and procedures to give accurate recommendations to suit clients' needs.
  • Collaborated with internal departments and external vendors to achieve fast resolution of claims.
  • Researched and analyzed complex claims to determine next steps and possible outcomes.
  • Worked productively in fast-moving work environment to process large volumes of claims.
  • Updated claims system to track claim status and provide relevant information to other department.
  • Analyzed and addressed escalated claims to resolve issues quickly.
  • Spearheaded the implementation of new claims software, leading to increased efficiency and better data management within the department.
  • Served as a subject matter expert on specialized claims, providing guidance and support to other team members when needed.
  • Demonstrated expertise in interpreting policy language accurately, leading to better-informed decisions on coverage application during claims evaluation.

Secretary

BELIEVE TRANSPORTATION LLC.
01.2019 - 07.2022
  • Enhanced office efficiency by streamlining filing systems and organizing documents.
  • Facilitated communication between departments for improved collaboration and project success.
  • Managed executive calendars, scheduling appointments and meetings to optimize time management.
  • Coordinated travel arrangements for senior staff, ensuring smooth business trips with minimal disruptions.
  • Provided exceptional customer service by promptly addressing inquiries and resolving issues professionally.
  • Supported human resources initiatives by assisting with recruitment, onboarding, and employee evaluations.
  • Conducted thorough research on industry trends or competitor activities that informed strategic decision-making processes.
  • Utilized advanced software programs for data entry tasks that increased accuracy while minimizing errors.
  • Collaborated with cross-functional teams on special projects to achieve successful outcomes within deadlines.
  • Provided clerical support to company employees by copying, faxing, and filing documents.
  • Entered data into system and updated customer contacts with information to keep records current.
  • Maintained electronic filing systems and categorized documents.
  • Updated spreadsheets and databases to track, analyze, and report on performance and sales data.
  • Surpassed team goals by partnering with colleagues to implement best practices and protocols.
  • Increased office participation in special events by creating newsletter with detailed calendars and other office updates.

Education

High School Diploma -

Ouachita Parish High School
Monroe, LA
05.2021

Skills

  • Team Collaboration
  • Policy Knowledge
  • Data Analysis
  • Workers Compensation
  • Time Management
  • File Management
  • Insurance Claims Review
  • Policy Understanding
  • Decision-Making
  • Claims Investigation
  • Interpersonal Communication
  • Flexible Schedule
  • Settlement Negotiation
  • Coverage Assessments
  • Accident Investigations
  • Documentation Review
  • Microsoft Office
  • Stress Management
  • Critical Thinking
  • Active Listening

Certification

PROPERTY AND CASUALTY LICENSE

References

References available upon request.

Timeline

Claims Representative

QUALITYS
08.2022 - 12.2023

Secretary

BELIEVE TRANSPORTATION LLC.
01.2019 - 07.2022

High School Diploma -

Ouachita Parish High School

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OLIVIA THOMAS