Tamela Walker
Memphis,TN
Summary
Experienced Claims Processor with a successful track record in managing health insurance claims, FMLA requests, and disability benefits. Strong problem-solving skills and solid understanding of claims processing systems and resources. Consistently processes over 150 claims per month, achieving a remarkable 30% reduction in processing time while maintaining strict compliance with HIPAA regulations. Highly skilled in prioritizing and organizing work to meet deadlines, collaborating effectively within teams, and utilizing a wide range of documentation and reference materials to ensure accuracy and efficiency.
Overview
9
9
years of professional experience
Work History
Medical Claims Processor
Activus Connect
08.2019 - Current
- Remote-based in Memphis, TN.
- Processed high volumes of medical claims accurately and efficiently under tight deadlines, ensuring prompt payment for services rendered.
- Maintained knowledge of benefits claim processing, claims principles, medical terminology, and procedures and HIPAA regulations.
- Monitored and updated claims status in claims processing system.
- Reviewed provider coding information to report services and verify correctness.
- Reduced errors in claims submissions through meticulous attention to detail and thorough review processes.
- Responded to correspondence from insurance companies.
- Streamlined communication between departments by developing efficient methods for sharing claim status updates and relevant documentation.
- Maintained a high level of customer satisfaction at 95% by promptly addressing inquiries and resolving issues related to medical claims.
- Stayed current on industry trends and changes in insurance policies, enabling accurate interpretation of coverage details for various plans.
Healthcare Customer Service Representative
Sitel
05.2016 - 08.2019
- Remote-based in Memphis, TN.
- Managed approximately 30 incoming calls per day from customers.
- Enhanced patient satisfaction by efficiently addressing and resolving healthcare-related inquiries.
- Ensured compliance with HIPAA regulations when handling sensitive patient information, protecting client privacy at all times.
- Managed difficult conversations with compassion and professionalism, helping deescalate tense situations while maintaining a focus on finding resolutions.
- Increased first-call resolution rates by carefully listening to customers' needs and providing accurate information based on their inquiries.
- Maintained accurate records of customer interactions, ensuring proper documentation within the company's database.
Education
No Degree -
Concorde Career College
Memphis, TN06-2018
Skills
- Critical Decision-Making
- Customer Service
- Claim Denial Resolution
- Claims Processing Proficiency
- HIPAA
- Continuous learning mindset
- Medical Terminology
- Teamwork and Collaboration
- Problem-Solving
- Time Management
- Attention to Detail
- ICD Codes
Accomplishments
- Achieved a 97% satisfaction rate through effectively helping with case management.
Timeline
Medical Claims Processor
Activus Connect
08.2019 - Current
Healthcare Customer Service Representative
Sitel
05.2016 - 08.2019
No Degree -
Concorde Career College
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