Summer Winters
Waterville,NY
Summary
Claims Examiner with deep knowledge of medical claims industry. Solid abilities in developing objectives and strategies to settle medical claims.
Overview
7
7
years of professional experience
Work History
Claims Examiner
Excellus BCBS
07.2021 - Current
- Maintained compliance with industry regulations and company policies while evaluating medical claims for accuracy and legitimacy.
- Supported team members during periods of high workload, providing guidance on challenging cases or offering assistance when needed.
- Managed large volume of medical claims on daily basis.
Health Benefits Specialist
Excellus BCBS
07.2021 - Current
- Improved customer satisfaction by actively listening to concerns and providing timely resolutions.
- Enhanced client retention rates by building strong relationships through consistent communication and followups.
- Assisted customers in navigating the company''s products and services, ensuring they received the best possible experience.
- Managed high call volumes while maintaining quality service standards, leading to positive feedback from customers.
- Maintained up-to-date knowledge of industry trends and changes, providing valuable insights to both customers and team members alike.
Prior Authorization Representative
Excellus BCBS
07.2021 - Current
- Improved patient satisfaction by efficiently processing prior authorization requests and ensuring timely responses.
- Reduced errors in documentation by meticulously reviewing medical records and verifying information accuracy.
- Enhanced team productivity with thorough training of new staff members on company policies and procedures.
- Ensured compliance with HIPAA regulations by maintaining strict confidentiality in handling sensitive patient information.
- Maintained up-to-date knowledge of industry trends, regulatory changes, and payer-specific guidelines to ensure accurate processing of requests.
Residential Treatment
Excellus BCBS
01.2017 - 06.2021
- Reviewed pre-admission referral reports and assisted in determining suitability for residential treatment.
Education
GED -
Educational Center Syracuse
Syracuse, NY05.2013
Skills
- Verbal Communication
- Claims Processing
- Time Management
- Data Verification
- Goal Setting
- Active Listening
- Decision-Making
- Relationship Building
- Multitasking Abilities
- Teamwork and Collaboration
Timeline
Claims Examiner
Excellus BCBS
07.2021 - Current
Health Benefits Specialist
Excellus BCBS
07.2021 - Current
Prior Authorization Representative
Excellus BCBS
07.2021 - Current
Residential Treatment
Excellus BCBS
01.2017 - 06.2021
GED -
Educational Center Syracuse
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