Roslyn Fulmore
Lake City,SC
Summary
Experienced with extensive knowledge of medical terminology and customer support. Offers strong dedication to informed patient care, administrative excellence, and confidentiality. Also, ready to offer genuine interest in helping others, ready to thrive in customer-focused environment.
Overview
8
8
years of professional experience
Work History
Claims Examiner
Cigna
Remote
02.2023 - 01.2025
- Maintained customer satisfaction with forward-thinking strategies focused on addressing customer needs and resolving concerns
- Developed and actualized customer service initiatives to decrease wait times
- Collected customer feedback and made process changes to exceed customer satisfaction goals
- Responded to customer requests for products, services and company information
- Obtained client medical history, medication information, symptoms, and allergies
- Performed medical records management, including filing, organizing and scanning documents
- Collected and documented patient medical information such as blood pressure and weight
- Documented vital signs and health history for patients in clinic and hospital environments
- Scheduled appointments, registered patients, and distributed sample pharmaceuticals as prescribed
- Collected pertinent data and calculations to aid physician in interpreting results
- Built strong relationships with patients through effective communication skills that foster trust in the clinic's commitment to quality care
- Verified insurance of patients to determine eligibility
- Filed and updated patient information and medical records
- Handled sensitive information with discretion, ensuring confidentiality of personal and financial details for claimants throughout the claims examination process.
- Utilized analytical skills to evaluate medical bills for accuracy and appropriateness of charges before approving payments as part of the claims process.
- Enhanced customer satisfaction by promptly addressing inquiries and providing accurate information on claim status.
- Researched claims and incident information to deliver solutions and resolve problems.
- Enhanced claim processing efficiency by conducting thorough investigations and maintaining accurate documentation.
- Monitored and updated claims status in claims processing system.
- Paid or denied medical claims based upon established claims processing criteria.
Certified Medical Assistant
MUSC Hospital
12.2019 - 10.2022
- Sanitized, restocked and organized exam rooms and medical equipment
- Conducted preliminary patient evaluations measuring weight, temperature and blood pressure
- Documented vital signs and health history for patients in clinic and hospital environments
- Directed patients to exam rooms, fielded questions and prepared for physician
- Assisted with routine checks and diagnostic testing by collecting and processing spoolliels
- Prepared and administered medications to alleviate patient symptoms
- Performed clerical duties, such as word processing, data entry, answering phones and filing
- Prepared patients for X-rays, electrocardiograms, suture removal and dressing changes
- Prepared lab specimens for diagnostic evaluation
- Communicated clearly and effectively with patients to verify information, determine purpose of visit and record medical history
- Directed patients to exam rooms, fielded questions, and prepared for physician examinations
- Called and faxed pharmacies to submit prescriptions and refills
Customer Service Representative
Sykes Kingstree
Kingstree, SC, USA
08.2016 - 03.2019
- Provided customers with account and billing information via chat and phone
- Constantly achieved quarterly metric goals and customer surveys
- Identified, researched, and resolved customer issues using the computer system
- Accurately captured and log customer information
- Processed orders, forms, applications and requests
Education
General Studies -
Lake City High School
Lake City, SC03.2016
Skills
- Customer service
- Time management
- Documentation review
- Microsoft Office
- Medical Terminology
- Medical Assisting
- EMR Systems
- Phone Etiquette
- Medical Billing
- Quality Assurance
- HIPAA
- Patient Care
- Insurance Verification
- ICD-10-cM coding
- Claim denial resolution
- Insurance claims processing
- Thorough claims reviews
Timeline
Claims Examiner
Cigna
02.2023 - 01.2025
Certified Medical Assistant
MUSC Hospital
12.2019 - 10.2022
Customer Service Representative
Sykes Kingstree
08.2016 - 03.2019
General Studies -
Lake City High School