Summary
Overview
Work History
Education
Skills
Timeline
Generic

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, NY
05.2013

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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Summer Winters