SherRon Wilson
Fort Worth,TX
Summary
Customer Service & Claims Specialist with 6+ years of experience in healthcare claims processing, disability claims, and high-volume customer support environments. Proven ability to process 200+ claims monthly with 98% accuracy while improving reimbursement timelines and customer satisfaction. Recognized for resolving complex issues efficiently, maintaining HIPAA compliance, and strengthening cross-functional communication. Adept at balancing service excellence with operational efficiency in remote and fast-paced settings.
Overview
9
9
years of professional experience
Work History
Claims Customer Service Representative
OptumRx
Remote
07.2024 - 02.2026
- Process and manage disability and pharmacy-related claims, ensuring timely and compliant resolutions.
- Authorize payments and escalate complex cases, minimizing delays and improving claim turnaround times.
- Provide high-quality member support, guiding medication options and resolving benefit inquiries to improve satisfaction and retention.
- Collaborate with internal departments to streamline claims workflows and reduce processing inefficiencies.
- Maintain strict adherence to HIPAA and organizational guidelines while handling sensitive health information.
Claims Representative
McKesson
Remote
12.2021 - 06.2023
- Processed 200+ oncology medical claims per month with 98% accuracy, accelerating insurance reimbursements and reducing denials.
- Improved accuracy of patient records across 100+ oncology cases, supporting timely treatment coordination.
- Resolved patient billing and insurance concerns with professionalism and discretion, maintaining high service standards.
- Reduced documentation errors by identifying inconsistencies and implementing corrective measures.
- Partnered with healthcare teams to ensure efficient information exchange between providers, insurers, and patients.
- Developed onboarding resources for new team members, improving training consistency and performance readiness.
Claims Representative
PFSweb
Remote
06.2019 - 12.2021
- Processed and adjudicated high-volume claims while ensuring compliance with internal policies and regulatory standards.
- Investigated and resolved complex claims issues by coordinating with clients, providers, and internal departments.
- Monitored claims data trends to identify improvement opportunities, enhancing workflow efficiency.
- Proactively followed up on pending cases, improving resolution timelines and customer satisfaction.
- Maintained quality control standards to ensure accurate assessments and reduce rework.
Claims Customer Service Representative
SPH Analytics
Fort Worth, TX
07.2017 - 05.2019
- Delivered high-volume customer support for disability-related inquiries and claims assistance.
- Resolved customer concerns promptly, strengthening trust and overall service experience.
- Escalated complex or high-risk cases appropriately to ensure compliance and resolution.
- Contributed to workflow improvements that enhanced team productivity and communication.
Education
High School Diploma -
Polytechnic High School
Fort Worth, TX2017
Skills
- Data entry proficiency
- Compliance awareness
- Call management
- Claims support
- Organization
- Customer service
- Problem-solving
- Time management
- Attention to detail
- Problem-solving abilities
- Claims investigation
- Organizing and prioritizing work
- Critical thinking
- Active listening
- Effective communication
- Team collaboration
Timeline
Claims Customer Service Representative
OptumRx
07.2024 - 02.2026
Claims Representative
McKesson
12.2021 - 06.2023
Claims Representative
PFSweb
06.2019 - 12.2021
Claims Customer Service Representative
SPH Analytics
07.2017 - 05.2019
High School Diploma -
Polytechnic High School