Sinthonia Nesbit
Snellville,GA
Summary
Dynamic Claims Benefit Specialist with extensive experience at KellyMitchell Group, excelling in claims analysis and regulatory compliance. Proven track record in resolving complex insurance claims and enhancing operational efficiency. Strong communication skills and a solid understanding of medical terminology contribute to successful collaboration across departments and improved client satisfaction.
Consummate Claims Associate knowledgeable in insurance coverage, policy terms and conditions. Facilitates claims processing by cultivating productive relationships with stakeholders. Blends analytical and administrative acumen throughout investigations and recommendations.
Overview
9
9
years of professional experience
Work History
Claims Benefit Specialist
KellyMitchell Group
01.2023 - Current
- Evaluated and settled complex insurance claims in strict timeframes.
- Worked with claims adjusters and examiners to expedite processing in alignment with procedures.
- Followed up with customers on unresolved issues.
- Processed and recorded new policies and claims.
- Reviewed outstanding requests and redirected workloads to complete projects on time.
- Coordinated with contracting department to resolve payer issues.
- Made contact with insurance carriers to discuss policies and individual patient benefits.
- Collected premiums and issued accurate receipts.
- Prepared insurance claim forms or related documents and reviewed for completeness.
Claims Processor
Insight Global
01.2020 - 08.2023
- 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.
- Complied with regulations and guidelines related to claims processing to maintain quality and adherence to standards.
- Utilized excellent analytical and problem-solving skills to quickly and accurately assess insurance claims.
- Developed and implemented quality assurance processes to check accuracy of claims processing.
- Tracked and reported on claims processing metrics to aid senior management in making informed decisions.
- Utilized specialized software to process incoming claims, enter data and generate reports.
- Reviewed applications and supporting documents to verify claims eligibility and accuracy.
- Carried out administrative tasks by communicating with clients, distributing mail, and scanning documents.
- Managed workload and priorities to meet claims processing meet deadlines.
- Collected premiums and issued accurate receipts.
- Posted payments to accounts and maintained records.
- Notified insurance agents and accounting departments of policy cancellations and changes.
- Calculated adjustments, premiums and refunds.
Claims Benefit Specialist
Kelly Temporary Services
01.2016 - 04.2020
- Evaluated and settled complex insurance claims in strict timeframes.
- Worked with claims adjusters and examiners to expedite processing in alignment with procedures.
- Followed up with customers on unresolved issues.
- Processed and recorded new policies and claims.
- Notified insurance agents and accounting departments of policy cancellations and changes.
- Reviewed outstanding requests and redirected workloads to complete projects on time.
- Resubmitted claims after editing or denial to achieve financial targets and reduce outstanding debt.
- Coordinated with contracting department to resolve payer issues.
- Made contact with insurance carriers to discuss policies and individual patient benefits.
- Communicated effectively with staff members of operations, finance and clinical departments.
- Maintained strong knowledge of basic medical terminology to better understand services and procedures.
Education
High School Diploma -
JANE ADDAM
The Bronx, NY01-1987
Skills
- Benefits administration
- Claims analysis
- Insurance regulations
- Policy interpretation
- Claims investigation
- Regulatory compliance adherence
- Time management
- Prior authorization processing
- Communication skills
- Medical terminology
Timeline
Claims Benefit Specialist
KellyMitchell Group
01.2023 - Current
Claims Processor
Insight Global
01.2020 - 08.2023
Claims Benefit Specialist
Kelly Temporary Services
01.2016 - 04.2020
High School Diploma -
JANE ADDAM
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