Skyler Johnson
Dallas
Summary
Detail-oriented professional driven to resolve claims fairly while representing interests of employer. Conducts thorough and informed investigations, precisely evaluates losses and negotiates settlements that satisfy diverse parties. Builds and maintains professional and productive relationships and works to understand potentially conflicting points of view.
Overview
10
10
years of professional experience
Work History
Claims Specialist II
MultiPlan
Irving
01.2022 - 08.2024
- Meet and maintain established departmental performance metrics. Manage high volume of claims in a queue; keep current with all claim actions and meet client deadlines for working and closing claims.
- Generated agreements through written and verbal communication with providers during negotiation process.
- Initiated provider calls to discuss proposals, overcame objections, and applied negotiation skills to resolve claims successfully.
- Address counter-offers received and present proposals for resolution while adhering to client guidelines and department goals.
- Identified potential savings opportunities with providers to enhance negotiation outcomes. with previously challenging providers to enhance negotiation outcomes.
- Engaged with Account Managers, Customer Relations, Provider Services, and direct client contacts to facilitate communication.
- Performing claim research to provide support for desired savings.
Provider Services
UnitedHealth Group
Richardson
05.2019 - 12.2022
- Answer incoming phone calls from health care providers (i.e. physician offices, clinics) and identify the type of assistance the provider needs (i.e. benefit and eligibility, billing and payments, authorizations for treatment and explanation of benefits (EOBs)
- Review and provide claim status to providers, verify allowed amounts and also make sure claims are paid correctly.
- Focus on resolving issues on the first call, navigate through the appropriate computer system(s) to identify the current status of the issue and provide appropriate response to caller
- Documented provider issues to track trends and enhance reporting accuracy.
- Achieved performance goals in efficiency, call quality, provider satisfaction, first call resolution, and attendance.
- Reviewed and communicated claim status to providers, ensuring accurate payment of claims and verification of allowed amounts.
Bankruptcy Specialist
Citi Financial
Irving
02.2016 - 04.2018
- Evaluated new accounts into Bankruptcy status
- Coded accounts impacted by bankruptcy filing
- Monitored reaffirmation agreements and maintained proof of claim forms to ensure compliance with bankruptcy regulations
- Reviewed claim status for processing
- Processed voluntary surrender request
- Provided information and assistance to Bankruptcy customers, enhancing their understanding of processes and options
- Working with internal and external customers to resolve problems or issues
- Entered data into systems accurately
- Answered inbound calls, addressing bankruptcy-related inquiries and guiding customers through resolution steps.
Customer Service Representative II
Aegis Communication Group
Irving
08.2014 - 12.2016
- Led customer service in the digital equipment division, focusing on answering customer queries, resolving issues, and sharing detailed information on new products.
- Generated repeat business through successful client follow-up
- Contributed to development of new policies and procedures to enhance customer service operations.
- Facilitated the training of new customer service representatives and associates.
- Assisted in the development of new policies and procedures.
- Performed market research surveys on customer needs and requirements.
- Cultivated repeat business through effective client follow-up strategies.
Education
Some College (No Degree) -
Dallas College
Dallas, TXSkills
- Customer claims assistance
- Quality assurance
- Data entry management
- Financial documentation
- Policy recommendations
- Problem resolution
- Account management
- Relationship management
- Logistics management
- Logistics coordination
- Data gathering
- Inventory handling
- FileNet
- Sales strategytration
- Account management
- Multitasking
- Listening skills
- Customer service
- Relationship management
Timeline
Claims Specialist II
MultiPlan
01.2022 - 08.2024
Provider Services
UnitedHealth Group
05.2019 - 12.2022
Bankruptcy Specialist
Citi Financial
02.2016 - 04.2018
Customer Service Representative II
Aegis Communication Group
08.2014 - 12.2016
Some College (No Degree) -
Dallas College