Summary
Overview
Work History
Education
Skills
Accomplishments
Certification
Work Availability
Work Preference
Software
Timeline
Generic
Paula Garnette

Paula Garnette

Claims Representative
Davenport,IA

Summary

Qualified Claims Representative versed in investigating claims, verifying information and managing settlements. Friendly and upbeat team player with organized and disciplined approach. Offering 5 years of insurance experience.

Overview

26
26
years of professional experience
4
4
Certification
14
14
years of post-secondary education

Work History

Reimbursement Warranty Claims Processor

Viva USA INC.
01.2022 - 02.2025
  • Collaborated with claims department and industry anti-fraud organizations to resolve claims.
  • Followed up with customers on unresolved issues.
  • Evaluated accuracy and quality of data entered into agency management system.
  • Reviewed applications and supporting documents to verify claims eligibility and accuracy.
  • Established positive and trusting relationships with injured clients, administering efficient customer service and processing claims quickly.
  • Assisted in onboarding of new claims processors to familiarize with company procedures, policies and processes.
  • Complied with regulations and guidelines related to claims processing to maintain quality and adherence to standards.
  • Developed and implemented quality assurance processes to check accuracy of claims processing.
  • Managed workload and priorities to meet claims processing meet deadlines.
  • Identified and reported potential fraud or abuse related to claims to protect system's integrity.
  • Utilized specialized software to process incoming claims, enter data and generate reports.
  • Utilized excellent analytical and problem-solving skills to quickly and accurately assess insurance claims.
  • Notified insurance agents and accounting departments of policy cancellations and changes.
  • Collected premiums and issued accurate receipts.
  • Carried out administrative tasks by communicating with clients, distributing mail, and scanning documents.
  • Made contact with insurance carriers to discuss policies and individual patient benefits.
  • Assured timely verification of insurance benefits prior to patient procedures or appointments.
  • Posted payments to accounts and maintained records.
  • Reviewed outstanding requests and redirected workloads to complete projects on time.
  • Calculated adjustments, premiums and refunds.
  • Modified, updated and processed existing policies.
  • Checked documentation for accuracy and validity on updated systems.
  • Processed and recorded new policies and claims.
  • Coordinated with contracting department to resolve payer issues.
  • Determined appropriateness of payers to protect organization and minimize risk.
  • Communicated effectively with staff members of operations, finance and clinical departments.
  • Generated, posted and attached information to claim files.
  • Verified client information by analyzing existing evidence on file.
  • Resubmitted claims after editing or denial to achieve financial targets and reduce outstanding debt.
  • Maintained confidentiality of patient finances, records, and health statuses.
  • Prepared insurance claim forms or related documents and reviewed for completeness.

Technical Support Representative

Kone
01.2021 - 12.2021
  • Used ticketing systems to manage and process support actions and requests.
  • Tested new software and hardware prior to deployment.
  • Offered assistance in implementing and developing training programs.
  • Managed high levels of call flow and responded to technical support needs.
  • Responded to customer inquiries and provided technical assistance over phone and in person.
  • Diagnosed and troubleshot hardware, software and network issues.
  • Helped streamline repair processes and update procedures for support action consistency.
  • Developed and implemented preventive maintenance procedures.
  • Removed malware, ransomware, and other threats from laptops and desktop systems.

Administrative Assistant

Lynch Heating & Plumbing
DAVENPORT
01.2020 - 12.2020
  • Payroll
  • Answered multi-line phone system, routing calls, delivering messages to staff and greeting visitors.
  • Maintained inventory of office supplies and placed orders.
  • Increased office participation in special events by creating newsletter with detailed calendars and other office updates.
  • Established administrative work procedures to track staff's daily tasks.
  • Surpassed team goals by partnering with colleagues to implement best practices and protocols.
  • Managed phone and email correspondence and handled incoming and outgoing mail and faxes.
  • Created and maintained detailed administrative processes and procedures to drive efficiency and accuracy.
  • Recorded new hires, transfers, terminations, changes in job classifications and merit increases to main human resources files.
  • Completed forms, reports, logs, and records to quickly handle all documentation for human resources.
  • Built and maintained excellent customer relationships through timely response to inquiries and going above and beyond to accommodate unusual requests.
  • Managed filing system, entered data and completed other clerical tasks.
  • Liaised between clients and vendors and maintained effective lines of communication.
  • Opened and properly distributed incoming mail to promote quicker response to client inquiries.
  • Continually sought methods for improving daily operations, communications with clients, recordkeeping, and data entry for increased efficiency.
  • Performed research to collect and record industry data.
  • Transcribed and organized information to assist in preparing speeches and presentations.
  • Facilitated timely delivery of special projects to meet organizational and departmental objectives.
  • Supported company leaders by managing budgets, scheduling appointments and organizing itinerary.
  • Volunteered to help with special projects of varying degrees of complexity.
  • Organized logistics and materials for each meeting and took detailed notes for later dissemination to key stakeholders.
  • Managed paper and electronic filing systems by routing various documents, taking messages and managing incoming and outgoing mail.
  • Interacted with vendors, contractors and professional services personnel to receive orders, direct activities, and communicate instructions.
  • Identified and recommended changes to existing processes to improve accuracy, efficiency, and quality service.
  • Assisted coworkers and staff members with special tasks on daily basis.

Transit Driver

City of Bettendorf
Bettendorf, IA
01.2010 - 03.2020

Millions of commuters across the country depend on a Transit Bus Driver to get them to and from work or other locations on a daily basis. The main responsibility that I as a Transit Bus Driver have, is to deliver passengers safely, while adhering to an established time schedule and route. I had extensive training and have to maintain a Class B driver's license with passenger endorsement is required. I currently started out with the Loop bus for the City of Bettendorf, then eventually moved to the city bus, in which I work days.

  • Maintained clean and neat shuttle for passenger comfort.
  • Operated with safety and skill to avoid accidents and delays.
  • Transported customers to and from [Location].
  • Accepted and processed fares.
  • Greeted customers with friendliness and professionalism, engaging in conversation to build rapport.
  • Followed company policies and procedures and maintained compliance with standards.
  • Followed predetermined routes to consistently meet targets and maintain schedules.
  • Provided information about routes, destinations and timelines to inform passengers.
  • Completed daily reports covering trip details, vehicle maintenance actions, and reportable incidents.
  • Assisted passengers with inquiries and requests during trips.
  • Aided passengers with disabilities or special needs.

School Bus Driver

Durham School Services
Bettendorf, IA
08.2007 - 12.2009
I was a professional school bus driver for Davenport Community Schools. I was responsible for safely operating the school bus according to a set daily schedule. I had to ensure that the school bus was in good operating condition at all times, pick
up and drop off students as per the schedule, maintain order and security on the bus and obey all laws, regulations and rules of conduct. I had to deal with residents and members of the public in a courteous and respectful manner. This includes receiving complaints about schedules and levels and quality of service. I had to make note of and report on any such complaints and respond in a courteous and respectful manner. I had to operate the School Bus in a safe manner at all times. Failure to ensure the safe passage of students to and from school may result in serious liabilities for a
settlement. Operating in an unsafe manner may result in injury or even the loss of life, which would have tragic consequences for the community as a whole.

School Bus Driver

Bettendorf Schools
Bettendorf, IA
08.2006 - 08.2007
I was a professional school bus driver for Davenport Community Schools. I was responsible for safely operating the school bus according to a set daily schedule. I had to ensure that the school bus was in good operating condition at all times, pickup and drop off students as per the schedule, maintain order and security on the bus and obey all laws, regulations and rules of conduct. I had to deal with residents and members of the public in a courteous and respectful manner. This includes receiving complaints about schedules and levels and quality of service. I had to make note of and report on any such complaints and respond in a courteous and respectful manner. I had to operate the School Bus in a safe manner at all times. Failure to ensure the safe passage of students to and from school may result in serious liabilities for asettlement. Operating in an unsafe manner may result in injury or even the loss of life, which would have tragic consequences for the community as a whole.

Bus Driver

First Student
Davenport, IA
02.2004 - 08.2006
I was a professional school bus driver for Davenport Community Schools. I was responsible for safely operating the school bus according to a set daily schedule. I had to ensure that the school bus was in good operating condition at all times, pickup and drop off students as per the schedule, maintain order and security on the bus and obey all laws, regulations and rules of conduct. I had to deal with residents and members of the public in a courteous and respectful manner. This includes receiving complaints about schedules and levels and quality of service. I had to make note of and report on any such complaints and respond in a courteous and respectful manner. I had to operate the School Bus in a safe manner at all times. Failure to ensure the safe passage of students to and from school may result in serious liabilities for asettlement. Operating in an unsafe manner may result in injury or even the loss of life, which would have tragic consequences for the community as a whole.

Correctional Officer

IL Department of Corrections
E. Moline, IL
01.2000 - 12.2000
I guarded inmates in penal institution in accordance with established policies, regulations, and procedures. I observed conduct and behavior of inmates to prevent disturbances and escapes. I Inspected locks, window bars, grills, doors, and gates for tampering. I did searches on inmates and cells for contraband articles. I Guarded and directed inmates during work assignments. I Patrolled assigned areas for evidence of forbidden activities, infraction of rules, and unsatisfactory attitude or adjustment of prisoners. I reported suspicious activity and observations to superior. I employed  force to maintain discipline and order among prisoners, if necessary. I escorted inmates to and from visiting room, medical office, and religious services. I guarded entrance of jail to screen visitors. I prepared written reports concerning incidences of inmate disturbances or injuries. I guarded prisoners in transit between jail, courtroom, traveling by automobile or public transportation.

Correctional Officer

Rock Island County Jail
Rock Island, IL
01.1999 - 12.1999
I guarded inmates in penal institution in accordance with established policies, regulations, and procedures. I observed conduct and behavior of inmates to prevent disturbances and escapes. I Inspected locks, window bars, grills, doors, and gates for tampering. I did searches on inmates and cells for contraband articles. I Guarded and directed inmates during work assignments. I Patrolled assigned areas for evidence of forbidden activities, infraction of rules, and unsatisfactory attitude or adjustment of prisoners. I reported suspicious activity and observations to superior. I employed  force to maintain discipline and order among prisoners, if necessary. I escorted inmates to and from visiting room, medical office, and religious services. I guarded entrance of jail to screen visitors. I prepared written reports concerning incidences of inmate disturbances or injuries. I guarded prisoners in transit between jail, courtroom, traveling by automobile or public transportation.

Education

Master of Science - Psychology

Kaplan University
Davenport, IA
04.2000 - 12.2013

Bachelor of Science - Criminal Justice

Kaplan University
Davenport, IA
2011

Associate of Arts - Law Enforcement

Scott Community College/Black Hawk College
Bettendorf, IA
2000

Skills

  • Criminal law knowledge
  • Crisis intervention training
  • Self-defense techniques
  • Search and seizure procedures
  • Correctional facility procedures knowledge
  • Suicide prevention training
  • Inmate behavior modification tactics
  • Firearm operations trained
  • FOID card holder
  • Safety and security-oriented
  • Strong interpersonal skills
  • Segregation unit specialist
  • Central and pod control
  • Conflict resolution skills
  • Team-oriented
  • Weapons training
  • Criminal law knowledge
  • Culturally-sensitive
  • 12-Steps program familiarity
  • Court testimony
  • Exceptional communicator
  • Strong work ethic
  • Highly organized
  • Report writing
  • Strong decision maker

Claims documentation

Secure data practices

Active listening

Premiums calculation

Accuracy and precision

Insurance plan verification

Organizational skills

Dispute resolution

Negotiation tactics

Payment and investigation escalations

Application review

Payments posting

Electronic authorization processing

Conflict resolution

Adaptability and flexibility

Medical terminology

Regulatory compliance

Reporting

Claims processing

Policy interpretation

10-key touch

Insurance calculation

Data entry proficiency

Verbal and written communication

Transactions reconciliation

Account management expertise

Decision-making

Office equipment operation

Policy implementation

Policy modification

Data entry software

Teamwork and collaboration

Detail orientation

Policy requirements and eligibility

Insurance rate standards

Problem-solving aptitude

Information verification

Written communication

Policy review

Liability management

Eligibility determination

Billing software

Insurance claim forms review

Technical writing

Time management

Regulatory compliance adherence

Professionalism

Communication skills

Premium calculation

Claims

Claims review

Excellent communication

Analytical thinking

Risk assessment

Reporting skills

Continuous improvement

Insurance confirmation

Google suite proficiency

Insurance regulations

Claims preparation

Claims trend analysis

Data management

Multi-tasking

Analytical skills

Critical thinking

Claims adjustment

Recordkeeping organization

Goal setting

Relationship building

Coverage determination

Organizing and prioritizing work

Proficient in [software]

Records management

Prior authorization processing

Research skills

Business correspondence

Data entry

Task prioritization

Personal data evaluation

Financial transactions

Customer service

Policy update coordination

Allocating claims

Settlement verification

Policy analysis

Financial analysis

Skilled in [software]

Technical aptitude

Policy renewals

Interpersonal skills

Fraud detection

Multitasking Abilities

Insurance coverage limits

Case management

Self motivation

Problem-solving abilities

Account management software

Quality control

Forms preparation

Professional demeanor

Accomplishments

  • CPR/First Aid Certifed
  • 12 Weeks of PTI Training for Corrections
  • CCW Permit

Certification

Certified Correctional Officer for the State of IL
Certified Correctional Officer for the City of Rock Island
Certified in CPR/First Aid

Work Availability

monday
tuesday
wednesday
thursday
friday
saturday
sunday
morning
afternoon
evening
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Work Preference

Work Type

Full TimePart TimeContract Work

Work Location

RemoteOn-SiteHybrid

Important To Me

Healthcare benefitsPaid sick leaveTeam Building / Company RetreatsPaid time offCompany CultureCareer advancement401k matchWork from home optionWork-life balanceStock Options / Equity / Profit Sharing4-day work week

Software

: MS, Unix ms, Careone 40, Citrex, Community Care, Consumer Data Base Online, ELGS, ETS, Facets, ICUE, IDRS, ISET, KL, Macess, PassPrime, Phycon, RX Claims, SVC KM-VCC Wand I have extensive experience in communication with providers across the US

Timeline

Reimbursement Warranty Claims Processor

Viva USA INC.
01.2022 - 02.2025

Technical Support Representative

Kone
01.2021 - 12.2021

Administrative Assistant

Lynch Heating & Plumbing
01.2020 - 12.2020

Transit Driver

City of Bettendorf
01.2010 - 03.2020

School Bus Driver

Durham School Services
08.2007 - 12.2009

School Bus Driver

Bettendorf Schools
08.2006 - 08.2007

Bus Driver

First Student
02.2004 - 08.2006

Master of Science - Psychology

Kaplan University
04.2000 - 12.2013

Correctional Officer

IL Department of Corrections
01.2000 - 12.2000

Correctional Officer

Rock Island County Jail
01.1999 - 12.1999

Bachelor of Science - Criminal Justice

Kaplan University

Associate of Arts - Law Enforcement

Scott Community College/Black Hawk College