Summary
Overview
Work History
Education
Skills
Timeline
Generic

Sherissee Anderson

Seffner,FL

Summary

Experienced Insurance Specialist successful at managing high caseloads in fast-paced environments. Organized, driven and adaptable with excellent planning and problem-solving abilities. Offering 6 years of experience and willingness to take on any challenge.

Overview

19
19
years of professional experience

Work History

Claims Processor/Medical Insurance Biller

Capital BlueCross
02.2022 - Current
  • Evaluated accuracy and quality of data entered into agency management system.
  • Collaborated with claims department and industry anti-fraud organizations to resolve claims.
  • Followed up with customers on unresolved issues.
  • Managed workload and priorities to meet claims processing meet deadlines.
  • Monitored claims processing trends to identify potential areas of improvement.
  • Assisted in onboarding of new claims processors to familiarize with company procedures, policies and processes.
  • Printed and reviewed monthly patient aging report and solicited overdue payments.
  • Collected payments and applied to patient accounts.
  • Researched CPT and ICD-9 coding discrepancies for compliance and reimbursement accuracy.
  • Liaised between patients, insurance companies, and billing office.
  • Examined patients' insurance coverage, deductibles, insurance carrier payments and remaining balances not covered under policies when applicable.
  • Precisely evaluated and verified benefits and eligibility.
  • Located errors and promptly refiled rejected claims.
  • Identified and resolved patient billing and payment issues.

Customer Service Supervisor

APAC Customer Services
02.2005 - 01.2020
  • Coached employees through day-to-day work and complex problems.
  • Coached team members to deliver hospitable, professional service while adhering to set service models.
  • Conducted training and mentored team members to promote productivity, accuracy, and commitment to friendly service.
  • Monitored metrics and developed actionable insights to improve efficiency and performance.
  • Actively supported service associates by quickly responding to questions via phone and email and finding appropriate solutions to customer issues.
  • Researched and corrected customer concerns to promote company loyalty.
  • Conducted training and mentored team members to promote productivity and commitment to friendly service.
  • Set priorities and problem-solved workflow issues to maintain rapport with customers and managers.
  • Responded to customer inquiries and resolved complaints to establish trust and increase satisfaction.

Customer Service Representative/Claims Team Leader

Aetna
12.2005 - 12.2019
  • Answered customer telephone calls promptly to avoid on-hold wait times.
  • Answered constant flow of customer calls with minimal wait times.
  • Provided primary customer support to internal and external customers.
  • Updated account information to maintain customer records.
  • Responded to customer requests for products, services, and company information.
  • Maintained customer satisfaction with forward-thinking strategies focused on addressing customer needs and resolving concerns.
  • Conducted file reviews, field re-inspections and staff ride alongs to assess staff accuracy and compliance.
  • Communicated with staff, leaders and peers to coordinate successful collaboration with other departments.
  • Submitted timely and accurate assessments of team performance to leadership with identification of areas of opportunity and outlined steps required to improve outcomes.
  • Identified insurance coverage limitations with thorough examinations of claims documentation and related records.
  • Organized, planned and documented materials for Workman Comp, Medicaid, Medicare, HMO/PPO claims.
  • Identified suspicious losses and contacted manager for investigative assistance.

Education

Bachelor of Science - Business Administration And Management

Prism Career Institute
Philadelphia, PA
07.2015

Skills

  • Customer Feedback
  • Financial Assistance
  • Past Due Balance Management
  • Transactions Reconciliation

Timeline

Claims Processor/Medical Insurance Biller

Capital BlueCross
02.2022 - Current

Customer Service Representative/Claims Team Leader

Aetna
12.2005 - 12.2019

Customer Service Supervisor

APAC Customer Services
02.2005 - 01.2020

Bachelor of Science - Business Administration And Management

Prism Career Institute
Sherissee Anderson