Paulisha Davis
Houston
Summary
Efficient professional in insurance claims and policy processing, known for high productivity and the ability to complete tasks with precision. Specialized in analyzing claim details, navigating policy databases, and managing customer communications. Excel in problem-solving, adaptability, and teamwork, leveraging these soft skills to navigate complex situations and achieve positive outcomes. Currently obtaining my TEXASALLADJUSTER License.
Overview
2
2
years of professional experience
Work History
Medical Claims Representative
Point32Health(Contract)
12.2024 - 03.2025
- Processed claims for payment or forwarded to appropriate personnel for further investigation
- Evaluated customer complaints, identified root causes, and took corrective action as appropriate.
- Assisted new policyholders with processing claims.
- Examined claims, records and procedures to grant approval of coverage.
- Inputted data into the system, maintaining accuracy of provider coding information and reported services.
- Handled billing related activities focused on medical specialties.
- Maintained detailed records of all activities related to claims processing.
- Organized information by using spreadsheets, databases or word processing applications.
- Attended meetings with internal staff members and external vendors as needed.
Insurance Verification Specialist
Onco360
06.2024 - 12.2024
- Verified patient insurance coverage, benefits, and eligibility for services across multiple insurance platforms.
- Utilized electronic medical records (EMR) systems for documenting verification processes.
- Participated in training sessions on new software programs used for verification purposes.
- Called insurance companies to ascertain pertinent information regarding policies and payment benefits for patients.
- Transmitted medical records and other correspondence by mail, e-mail, or fax.
- Researched third party payer guidelines related to prior authorizations, coding and billing processes.
- Identified discrepancies in patient's insurance coverage or benefits, ensuring accuracy of data entered into system.
Insurance Verification Specialist
McKesson(contract)
01.2023 - 01.2024
- Identified discrepancies in patient's insurance coverage or benefits, ensuring accuracy of data entered into system.
- Checked documentation for appropriate coding, catching errors and making revisions.
- Called insurance companies to ascertain pertinent information regarding policies and payment benefits for patients.
- Interpreted Explanation of Benefits statements from various insurers and communicated relevant information with other departments as needed.
- Participated in audits and quality assurance activities related to insurance verification.
- Verified patient eligibility for insurance coverage by contacting insurance carriers and obtaining the necessary authorization numbers.
- Accessed third-party insurance databases to identify coverage of benefits.
- Responded to patient inquiries regarding insurance coverage and billing issues.
- Monitored and tracked the status of pending insurance verifications and authorizations.
- Responded promptly to customer inquiries regarding their benefits and eligibility status.
Education
High School Diploma -
Lincoln Academy High School
06-2011
Adjuster License - Insurance Adjuster
The Adjuster School
Skills
- Claims processing
- Claims processing proficiency
- Legal compliance
- Caseload management
- Problem-solving
- Multitasking and organization
- Customer service
- Telephone etiquette
- Policy investigations
- Verbal and written communication
- Persistence
- Claims investigation
Education and Training
true,other,other
References
References available upon request.
Timeline
Medical Claims Representative
Point32Health(Contract)
12.2024 - 03.2025
Insurance Verification Specialist
Onco360
06.2024 - 12.2024
Insurance Verification Specialist
McKesson(contract)
01.2023 - 01.2024
Adjuster License - Insurance Adjuster
The Adjuster School
High School Diploma -
Lincoln Academy High School
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