Paris Spears
Columbus
Summary
Detailed Claims Processor with 10 years of experience investigating claim information for correctness. Trustworthy teammate with benefit knowledge and rapport-building skills. Noted for thoroughness and ethical customer service. Seasoned Claims Processor evaluating online entry, error correction and quality control review for final adjudication of claims. Strong business and financial acumen with proven success to maintain efficient operations. Extensive knowledge of billing, collections and fiduciary management.
Overview
40
40
years of professional experience
Work History
Clek/Secretary
United States Post Office
Colmbus
06.1993 - Current
- Answered telephone calls to give information to callers, take messages or transfer calls to appropriate individuals.
- Maintained organized filing system of paper and electronic documents.
- Coordinated communications, taking calls, responding to emails and interfacing with clients.
- Greeted visitors and directed to appropriate location or person.
- Sent and distributed mail and parcels.
Claims Processor/Data Entry
Blue Cross and Blue Shield
Cleveland
01.1986 - 06.1993
- Verified claim data correctness in preparation for processing.
- Processed claims according to established quality and production standards and made corrections and adjustments to solve problems.
- Reviewed history records to determine benefit eligibility for services.
- Addressed customer inquiries to provide information and explanations on coverage and terms, expediting claims.
- Researched medical claims for validity to resolve discrepancies.
- Conducted and documented comprehensive investigations to negotiate settlements or deny claims.
- Identified client service improvement opportunities in collaboration with team leads and managers to resolve problems.
- Built rapport and trust with injured insureds through effective customer service techniques which involved fair and prompt processing of claims.
- Examined claims, records and procedures to grant approval of coverage.
- Assisted claimants, providers and clients with problems or questions regarding claims.
- Processed claims for payment or forwarded to appropriate personnel for further investigation
- Retained strong medical terminology understanding in effort to better comprehend procedures.
- Called insurance companies to ascertain pertinent information regarding policies and payment benefits for patients.
- Precisely calculated refunds, premiums and adjustments.
- Assisted new policyholders with processing claims.
- Checked documentation for appropriate coding, catching errors and making revisions.
- Prepared and reviewed insurance-claim forms and related documents for completeness.
Education
High School Diploma -
Charles F. Brush High School
Lyndhurst, OH06.1993
Certificate - Medical Assisting
MCI School of Technology
Cleveland, Ohio01.1985
Some College (No Degree) - General Studies
Cuyahoga Community College
Cleveland, OHSkills
- New Policies Processing
- Customer Service
- Policy Modifications and Updates
- Problem-Solving
Timeline
Clek/Secretary
United States Post Office
06.1993 - Current
Claims Processor/Data Entry
Blue Cross and Blue Shield
01.1986 - 06.1993
High School Diploma -
Charles F. Brush High School
Certificate - Medical Assisting
MCI School of Technology
Some College (No Degree) - General Studies
Cuyahoga Community College