Paige Tinsley

• Support Medicare members through Direct Member Sales while ensuring CMS and Humana compliance.
• Review eligibility, enrollment documentation, and coverage changes for accuracy and regulatory adherence.
• Identify documentation discrepancies, eligibility inconsistencies, and irregular patterns requiring escalation.
• Maintain audit-ready records in accordance with HIPAA and PHI standards.

• Assisted clients in understanding complex insurance policies, ensuring they made informed decisions when selecting coverage options.
• Conducted comprehensive policy reviews for existing clients, identifying opportunities for adjustments or additional coverage.
• Managed a diverse portfolio of health insurance accounts while consistently meeting sales targets and exceeding performance expectations.

• Medicare Supplement Sales for AARP UHC
• Assisted clients in understanding complex insurance policies, ensuring they made informed decisions when selecting coverage options.
• Maintained up-to-date knowledge of industry trends and regulatory changes, providing accurate advice to clients and staying ahead of competitors.
• Answered inbound calls from existing and future policyholders to answer inquiries and discuss insurance options.

• Conducted fraud and chargeback investigations in compliance with Visa and Mastercard regulations.
• Reviewed transaction documentation, merchant responses, and cardholder claims to assess risk and validity.
• Analyzed dispute trends and fraud indicators; maintained audit-ready investigative documentation.

• Investigated complex member disputes and fraud claims under Signature First Chargeback rules.
• Applied federal regulations and card-network guidelines to determine outcomes.
• Processed provisional and permanent credits; documented findings to minimize financial exposure.

• Investigated suspicious account activity and banking claims through transaction review and pattern recognition.
• Minimized fraud and financial loss by initiating account protections and reissuance actions.
• Maintained accurate, defensible documentation in accordance with internal and regulatory standards.

Review customer accounts for prevention and detection Research and analyze account activity to assess the levels of risk

fraud type

• General customer service such as reviewing transactions, billing,balance transfers, online banking support and card replacement.

• Initiate fraud claims and billing disputes for proper resolution