Samathia James
Duluth,GA
Summary
Effective Medical Claims Processor with strong background building rapport with providers to discuss claim status or claim denials. Driven performer equipped to handle multiple administrative tasks effectively. Exemplary worker with highly investigative skills when processing claims.
Overview
7
7
years of professional experience
Work History
Customer Care Representative
UnitedHealthcare
10.2023 - Current
- Continuously sought self-improvement opportunities through ongoing education and professional development programs related to the field of customer care.
- Conducted follow-up calls to ensure complete resolution of customer concerns and verify satisfaction levels.
- Enhanced customer satisfaction by promptly addressing inquiries and resolving issues.
- Collaborated with cross-functional teams to resolve complex customer issues in a timely manner.
- Built rapport with customers through active listening and empathetic responses, fostering positive relationships.
- Implemented feedback from supervisors to continuously improve performance and enhance customer care skills.
Claims Supervisor
Elevance Anthem Inc.
11.2016 - 08.2023
- Supervised a team of customer service representatives, fostering a positive and efficient work environment
- Conducted regular training sessions to ensure staff proficiency in insurance verification, benefit investigation, and prior authorization procedures
- Assisted in the development and implementation of effective customer service strategies, resulting in a significant improvement in patient and provider satisfaction
- Collaborated with cross-functional teams to address complex insurance-related issues, ensuring prompt resolution.
- Collaborated with healthcare providers to ensure accurate billing and reduce disputes.
- Streamlined communication between departments, ensuring timely updates on claim status and relevant issues.
Education
TECHNICAL HIGH SCHOOL DIPLOMA -
Central High School
Skills
- EPIC experience
- Analytical and problem-solving skills
- Attention to detail
- Microsoft Office
- Problem Solving
- Strong knowledge of Medicare and Medicaid
- Exceptional communication
- Leadership
- Prior Authorizations
- Process Improvement
- Claims Processing
- Complex Mathematics
- Decision-Making
Timeline
Customer Care Representative
UnitedHealthcare
10.2023 - Current
Claims Supervisor
Elevance Anthem Inc.
11.2016 - 08.2023
TECHNICAL HIGH SCHOOL DIPLOMA -
Central High School