Summary
Overview
Work History
Education
Skills
Timeline
Generic

RahQuerrah Wilson

Spring

Summary

Skilled in handling complex insurance claims and policy processing with experience in navigating through various insurance software systems. Demonstrates strong analytical skills, adept at interpreting policies and efficiently resolving claims to the satisfaction of all parties involved. Known for maintaining high accuracy levels in document processing and data entry, contributing to streamlined operations and improved customer service outcomes. Continuously seeks ways to optimize workflows and enhance team productivity, leading to more efficient claim resolution processes.

Overview

6
6
years of professional experience

Work History

Claims Representative

BroadPath Healthcare
Remote
01.2021 - 01.2025
  • Reviewed and processed medical claims for accuracy and completeness, ensuring adherence to billing regulations and insurance policies
  • Submitted claims to insurance companies electronically or by mail, following proper coding and documentation guidelines
  • Investigated and resolved claim denials, rejections, and billing discrepancies, working closely with healthcare providers and insurers to facilitate payment
  • Communicated with patients regarding insurance coverage, billing inquiries, and payment options, providing assistance and support as needed
  • Maintained accurate records of claim status, payments, and follow-up actions, ensuring timely resolution and reimbursement

Enrollment Specialist

Ambetter
12.2018 - 01.2021
  • Respond to inbound calls and inquiries from individuals seeking information on healthcare plans and enrollment options
  • Provide clear and accurate explanations of healthcare benefits, coverage options, and eligibility requirements
  • Assist customers in selecting the appropriate healthcare plan based on their needs and financial situation
  • Guide customers through the healthcare enrollment process, including completing applications and submitting required documentation
  • Verify customer information and ensure all data is accurately entered into the enrollment system
  • Meet or exceed performance metrics related to customer satisfaction, call handling time, and enrollment accuracy

Education

Associate of Applied Science - Psychology

Houston Community College
Houston, TX
02-2028

Skills

  • Insurance verification
  • Appointment scheduling
  • Call center experience
  • Claims processing
  • HIPAA compliance
  • Customer service
  • EMR
  • Problem-Solving
  • Data entry
  • Medical billing
  • Benefit verification
  • Customer Relationship Management (CRM)

Timeline

Claims Representative

BroadPath Healthcare
01.2021 - 01.2025

Enrollment Specialist

Ambetter
12.2018 - 01.2021

Associate of Applied Science - Psychology

Houston Community College

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