Sonia Spratlin

Investigated and resolved complex claims discrepancies, achieving a 25% decrease in aged claims
inventory.
Conducted root cause analysis for denied claims, implementing corrective actions that improved
claims acceptance rates by 18%.
Maintained compliance with HIPAA and other regulatory standards while processing sensitive
client data.
Developed relationships with providers and internal stakeholders to expedite resolution times and
improve claims workflows.

Updated job knowledge by participating in educational opportunities; reading professional publications; maintaining personal networks; participating in professional organizations .

Managed escalated customer complaints pertaining to denied or delayed payments in a timely manner.

Processed a high volume of incoming claims in accordance with established policies and procedures.

Provided technical guidance and training to new staff members regarding claim processing procedures.

Provided exceptional customer service by addressing inquiries promptly and professionally.

Adhered to all applicable laws, regulations, and company standards while processing claims.

Maintained detailed records of customer interactions using contact management software.

Identified customer needs by asking probing questions and actively listening to responses.

Assisted customers with inquiries, issues and complaints via telephone, email and chat.

Utilized problem solving techniques when dealing with difficult or irate customers.

Ensured compliance with all applicable laws, regulations, policies and procedures related to customer service activities.

Provided accurate information on products and services to customers.