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
2500 Elmerton Ave Harrisburg Pa 17177
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
111 S US 301 Tampa, Fl 33619
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
3611 Queen Palm Drive Tampa Fla 33619
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, PA07.2015
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