Ronda Black
Smyrna,TN
Summary
Experienced Claims Examiner with over 10 years in claims adjudication. Excellent at performing non-clinical activities and functions in accordance with policies and procedures, under the supervision of the Clinical Supervisor. With over 10 years of healthcare related experience. Great at reviewing and maintaining compliance with ERISA, CMS, Medicaid, and client specific requirements. Exceptional written and verbal communication.
Overview
17
17
years of professional experience
Work History
All lines Auto Claims Adjuster (Remote)
Alacrity Solutions
10.2021 - 12.2023
- Investigated and determined liability for claims with high complexity, and liability issues
- Evaluated damages, and managed claim negotiations with insureds, claimants, and attorneys
- Communicated liability decision to customers, claim specialists, and underwriting
- Managed first party, multi-line claims across all operating territories
- Investigated and recognized all potential claim exposures.
Auto Claims Adjuster (Remote)
Progressive Insurance
01.2023 - 10.2023
- Identified and assessed auto damage and informed clients about necessary repairs
- Communicated with policy holders, clients, police, and necessary parties
- Performed thorough inspection of vehicles and created proper estimates
- Worked closely with automobile professionals to discuss repair pricing and assess liability
- Aimed to provide clients with the highest level of customer service possible.
Medical Reimbursement Specialist III (Remote)
Permian Premier Health
04.2019 - 06.2021
- Maintained cash application function for managed care, commercial, Medicare and Medicaid
- Reviewed Medicaid, Medicare, and Marketplace claims for overpayments
- Lead and delegated audit assignments for prompt internal/external audit requests
- Processed appeals for both government and commercial payors
- Prepared written provider overpayment notification and supporting documentation with determination.
Grievance and Appeals Specialist (Hybrid)
Community Health Systems
02.2017 - 02.2019
- Tracked, monitored, and resolved Grievance and Appeals Cases
- Analyzed data for Grievance and Appeals Process for Medicare Advantage plan
- Maintained a Log of Grievance and Appeals cases for tracking and CMS reporting purposes
- Interfaced with internal departments and external vendors
- Created appeals response letter giving determination to customer.
Manager Commercial Mobile
T-Mobile
01.2016 - 02.2017
- Worked directly with leadership to hire new sales agents and develop training materials
- Traveled to local businesses for one-on-one customer support
- Utilized sales force automation, funnel management and prospecting tools.
Business Sales Manager
ADT
09.2012 - 08.2015
- Created and executed a strategic sales plan that expanded the customer base
- Met with potential clients and created long-lasting relationships that addressed their needs
- Recruited sales representatives, set goals, trained, coached, and monitored performance
- Identified knowledge gaps within the team and developed plans for filling them
- Ensured that company quotas were met by setting and evaluating current sales goals monthly
- Increased business client base by 22% over 3 years and increased revenue by 13%.
DMERC Grievance & Appeals Representative
Amerigroup Community Care
03.2007 - 10.2011
- Assisted members in acquiring durable medical equipment through Medicaid and Medicare
- Reviewed appeals cases and ensured that information is correct
- Sent all documentation to CMS review entity Maximus Federal Services for further review
- Collected documentation to process claims with updated diagnosis codes and relative medical information
- Developed correspondence communicating the outcome of grievances and appeals to enrollees and/or providers
- Reported collected data to CMS monthly.
Education
Masters in Business Management/Marketing -
Walden University
Minneapolis, MN10.2010
Skills
- Excellent Investigation Skills
- Data Entry
- Knowledge of Insurance Policies
- Business Efficiency
- Data Collection and Analysis Skills
- Experienced in Computer Based Research Programs
- Customer Service and Support
- Issue Resolution
Timeline
Auto Claims Adjuster (Remote)
Progressive Insurance
01.2023 - 10.2023
All lines Auto Claims Adjuster (Remote)
Alacrity Solutions
10.2021 - 12.2023
Medical Reimbursement Specialist III (Remote)
Permian Premier Health
04.2019 - 06.2021
Grievance and Appeals Specialist (Hybrid)
Community Health Systems
02.2017 - 02.2019
Manager Commercial Mobile
T-Mobile
01.2016 - 02.2017
Business Sales Manager
ADT
09.2012 - 08.2015
DMERC Grievance & Appeals Representative
Amerigroup Community Care
03.2007 - 10.2011
Masters in Business Management/Marketing -
Walden University
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