Shay Thurston
Erie,Pennsylvania
Summary
Proactive and friendly Claims Adjuster dedicated to exceeding expectations in every interaction. Exceptional communication skills and a knack for building and nurturing relationships drive effective business retention. Seeking a role to leverage education and experience for immediate value addition to an organization. Thrives on workplace challenges that push to be the best in the role, regardless of the establishment. Possesses extensive knowledge and a strong ability to quickly learn new tasks.
Overview
8
8
years of professional experience
Work History
Claims Adjuster
Highmark Health
Remote
10.2022 - Current
- Resolved complex claims issues for expedited processing and resolution.
- Assisted in the creation of departmental procedures and guidelines to maintain consistency across all team members'' work quality standards.
- Evaluated new software tools that improved productivity levels while maintaining accuracy standards.
- Managed high volume caseloads, prioritizing urgent and sensitive cases for immediate attention.
- Conducted thorough investigations of medical claims to ensure proper payment or denial.
- Reviewed provider coding information to report services and verify correctness.
- Maintained knowledge of benefits claim processing, claims principles, medical terminology, and procedures and HIPAA regulations.
- Researched and resolved complex medical claims issues to support timely processing.
Key Sales Assoicate
Banter By Piercing Pagoda
Erie, Pennsylvania
09.2019 - Current
- Receive payment by cash, check, credit cards, vouchers, or automatic debits
- Resolve customer complaints regarding sales and service
- Promote sales
- Called clients to confirm upcoming appointments
- Bag, box, wrap, or gift-wrap merchandise
- Process merchandise returns and exchanges
- Answer questions about product features and benefits.
Premier Accounts Customer Advocate
Highmark Health
Erie, Pennsylvania
10.2017 - 11.2022
- I am responsible for the handling of customers insurance policy inquiries and issuing member mail communications for quote coverage
- Customer advocacy contact to providers to ensure correct billing and coding
- Status of health insurance authorizations for surgical and diagnostic procedures
- Standing of provider participation, All of my responsibilities include sound ability to troubleshoot any issues that may be presented while rendering efficient
- Contact customers to respond to inquiries or to notify them of claim investigation results or any planned adjustments.
- Provided mentoring for new employees
Sales/Customer Service
CPS Keystone
Erie, Pennsylvania
03.2016 - 10.2017
- Keep records of customer interactions or transactions, recording details of inquiries, complaints, or comments, as well as actions taken
- Check to ensure that appropriate changes were made to resolve customers' problems
- Solicit sales of new or additional services or products
- Recommend improvements in products, packaging, shipping, service, or billing methods and procedures to prevent future problems.
Education
Associates - Business, Marketing & Management
Fortis Institue
Fairview Township, Pennsylvania06.2016
Skills
- Excellent communication skills both verbal and written
- Savvy in Microsoft Office including MS Word, MS Excel, and MS Powerpoint (PP Certification)
- Filing and record keeping
- Experience in Health Care insurance coverage
Timeline
Claims Adjuster
Highmark Health
10.2022 - Current
Key Sales Assoicate
Banter By Piercing Pagoda
09.2019 - Current
Premier Accounts Customer Advocate
Highmark Health
10.2017 - 11.2022
Sales/Customer Service
CPS Keystone
03.2016 - 10.2017
Associates - Business, Marketing & Management
Fortis Institue