Shabria Williams
Titusville,FL
Summary
Results-driven Claims Examiner I at Health First Health Plans, adept at claims processing and data verification. Streamlined workflows to enhance efficiency, significantly reducing processing time. Proven expertise in critical thinking and customer service, ensuring compliance and accuracy in claims evaluation while maintaining confidentiality of sensitive information.
Overview
7
7
years of professional experience
Work History
Claims Examiner I
Health First Health Plans
03.2023 - Current
- Handled sensitive information with discretion, ensuring confidentiality of personal and financial details for members throughout the claims examination process.
- Utilized analytical skills to evaluate for accuracy and appropriateness of charges before approving payments as part of the claims process.
- Implemented efficient workflow strategies to reduce claim processing time.
- Maintained detailed records of all claims activities, ensuring compliance with regulatory requirements and company policies.
Intake Specialist
Adapt Health
Remote
03.2022 - 03.2023
- Answered phone calls and provided new clients with required paperwork to initiate service.
- Increased customer satisfaction with timely follow-ups, ensuring all necessary documentation was collected and processed promptly.
- Completed intake assessment forms and filed clients' charts.
- Maintained high levels of accuracy and compliance in data entry, ensuring all information was correctly entered into the required systems.
Customer Service Representative
Health First Health Plans
Rockledge, FL
07.2018 - 02.2022
- Managed high-stress situations effectively, maintaining professionalism under pressure while resolving disputes or conflicts.
- Resolved customer complaints with empathy, resulting in increased loyalty and repeat business.
- Handled escalated calls efficiently, finding satisfactory resolutions for both customers and the company alike.
- Responded to customer requests for products, services, and company information.
- Enhanced customer satisfaction by promptly addressing concerns and providing accurate information.
- Maintained detailed records of customer interactions, ensuring proper follow-up and resolution of issues.
Education
High School Diploma -
Cocoa High
Cocoa, FL05.2010
Skills
- Claims processing
- Verbal communication
- Data verification
- Healthcare procedures
- Computer skills
- Claims evaluation
- Decision-making
- Customer service and support
- Payment processing
- Claims
- Critical thinking
- MS office
- Denied claims identification
- Claims investigation
- File and record management
- Team collaboration
- Benefits review
Timeline
Claims Examiner I
Health First Health Plans
03.2023 - Current
Intake Specialist
Adapt Health
03.2022 - 03.2023
Customer Service Representative
Health First Health Plans
07.2018 - 02.2022
High School Diploma -
Cocoa High