Sophie Louis
Kissimmee,United States
Summary
Knowledgeable administrative professional with solid background in insurance policy processing. Makes accurate determinations about policies and claims by diligently analyzing statements, account records and other documentation. Trained in calculating numbers for premiums and reserve requirements.
Overview
5
5
years of professional experience
Work History
Grievance Appeals Specialist
United Healthcare
Miami, Florida, United States
07.2023 - Current
- Ensured compliance with federal, state, and local regulations governing healthcare appeals processes
- Composes all correspondence and appeal/dispute and or grievances information concisely and accurately, in accordance with regulatory requirements.
- Resolves and prepares written response to incoming provider reconsideration request is relating to claims payment and requests for claim adjustments or to requests from outside agencies
- Responsible for contacting the member/provider through written and verbal communication.
- Maintained strict confidentiality of patient information in accordance with HIPAA regulations
- Tracked and monitored appeals inventory to ensure timely processing within regulatory guidelines.
Insurance Specialist
Blue Cross Blue Shield of Washington
Miami, Florida, United States
03.2021 - 06.2023
- Prepared comprehensive reports outlining client portfolios, coverage levels, premiums paid, and policy expiration dates
- Utilized multiple communication channels such as phone calls, emails, and social media platforms to engage with prospective clients
- Negotiated claim settlements between clients and insurance companies to ensure fair outcomes for all parties involved.
Receptionist
Carter Wiggins & Associate, P.A
Miami, Florida, United States
06.2019 - 03.2020
- Operated office equipment such as photocopiers, fax machines, and printers efficiently
- Greeted and welcomed visitors upon arrival, ensuring they felt comfortable
- Assisted with administrative tasks such as filing, copying, and data entry as needed
- Handled cash transactions related to services rendered at the front desk (e.g., notary public fees)
- Answered incoming phone calls and provided information or transferred calls accordingly
- Scheduled appointments for staff members and clients in an organized manner.
Education
Associate in Arts (A.A.) -
Miami Dade Colleg
Miami, Florida05.2022
Skills
- Professionalism
- Legal Research
- Computer Literacy
- Effective Communication
- Decision Making
- Team Leadership
- Management
Timeline
Grievance Appeals Specialist
United Healthcare
07.2023 - Current
Insurance Specialist
Blue Cross Blue Shield of Washington
03.2021 - 06.2023
Receptionist
Carter Wiggins & Associate, P.A
06.2019 - 03.2020
Associate in Arts (A.A.) -
Miami Dade Colleg