Rachel Graham
Buffalo,NY
Summary
Diligent Claims Processor versed in insurance processes as well as claims and adjustment procedures. Offers great attention to detail and time management abilities to successfully handle large volume of claims. Highly accurate and thorough with focus on completing error-free work in line with processing guidelines.
Overview
10
10
years of professional experience
Work History
Claims Adjuster
Highmark Blue Cross Blue Shield
08.2017 - Current
- Manage high volume of claims and adjustments, prioritizing tasks to meet deadlines while maintaining quality and compliance
- Review supporting documents to verify claims eligibility and accuracy
- Apply medical necessity guidelines, determine coverage, and apply all cost measures to assist in the claim adjudication process
- Determine and complete adjustments on claim overpayments and underpayments
- Reviewed and analyzed claims to ensure accuracy, completeness, and compliance with company policies.
Member Service Representative
Highmark Blue Cross Blue Shield
10.2015 - 08.2017
- Assisted a large volume of customers every day with positive attitude and focus on customer satisfaction.
- Provided exceptional service through active listening, understanding member needs, and offering appropriate solutions.
- Enhanced customer satisfaction by efficiently addressing and resolving inquiries and concerns.
- Maintained high-quality service by adhering to company policies and standards in all member interactions.
- Educated member and providers on billing procedures, coding guidelines, and reimbursement policies for optimal claim submissions.
Education
Associate of Science - Health Information Technology
Erie Community College
Buffalo, NY05-2022
Skills
- Highly Motivated
- Detail Oriented
- Critical thinking
- Problem Solving
- Accuracy and precision
- Insurance regulations
- Claims processing software
- Claims investigation
- Medical terminology
- Data entry proficiency
Timeline
Claims Adjuster
Highmark Blue Cross Blue Shield
08.2017 - Current
Member Service Representative
Highmark Blue Cross Blue Shield
10.2015 - 08.2017
Associate of Science - Health Information Technology
Erie Community College
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