Regina Tindal
Blue Cross Blue Shield
Sumter,SC
7
years of professional experience
Detail-oriented professional with expertise in claims processing and customer service. Proven ability to ensure accuracy and compliance while providing exceptional support to clients.
Work History
Claims Processor
1 Year 9 Months- Reviewed claim submissions for accuracy and compliance with company policies.
- Processed incoming claims efficiently, ensuring timely resolution of issues.
- Collaborated with cross-functional teams to streamline claims processing workflows.
- Utilized electronic claims processing systems to manage and track claim statuses.
- Assisted in training new employees on claims procedures and operational guidelines.
- Identified discrepancies in claims and initiated corrective actions to enhance accuracy.
- Monitored compliance with regulatory requirements, contributing to risk mitigation strategies.
- Reviewed and analyzed claims to ensure accuracy, completeness, and compliance with company policies.
Customer Care Representative
2 Years 5 Months- Resolved customer inquiries through effective communication and problem-solving techniques.
- Processed transactions accurately while adhering to compliance guidelines and banking policies.
- Assisted clients with account management, providing tailored solutions for their financial needs.
- Utilized CRM software to track interactions and ensure timely follow-up on customer requests.
- Identified opportunities for process improvements, contributing to streamlined workflows within the department.
- Facilitated feedback sessions to gather insights from customers, driving enhancements in service quality.
- Helped large volume of customers every day with positive attitude and focus on customer satisfaction.
- Managed high call volume with exceptional professionalism and efficiency.
Member Service Representative
2 Years 10 Months- Provided customer service and support to health plan members by phone.
- Assisted members with questions regarding benefits, eligibility, claims, coverage, and account information.
- Verified member information and maintained confidentiality in accordance with HIPAA requirements.
- Researched and resolved member concerns while providing accurate and timely information.
- Explained healthcare benefits, policies, procedures, and available services in an easy-to-understand manner.
- Assisted members with provider information, billing questions, and claims-related concerns.
- Documented member interactions and resolutions accurately in company systems.
- Escalated complex issues to the appropriate department when necessary.
- Handled high-volume calls while maintaining professionalism, accuracy, and empathy.
- Followed company policies, quality standards, and compliance requirements.
- Met established goals for call quality, productivity, customer satisfaction, and attendance.
- Demonstrated strong communication, problem-solving, and conflict-resolution skills.
Education
- Healthcare
Skills
Claims review
Accuracy and precision
Transactions reconciliation
Claims
Data entry proficiency
Payments posting
Attention to detail
Data entry
Critical thinking
Claims adjustment
Microsoft office
Customer service
Decision-making
Teamwork and collaboration
Timeline
Claims Processor
Blue Cross Blue Shield
01.2025 - CurrentRead More
Customer Care Representative
PNC Bank
07.2022 - 12.2024Read More
Member Service Representative
BroadPath Healthcare
09.2019 - 07.2022Read More
Ultimate Medical Academy
from Healthcare
Read More