Tear Harris
Elevance Health
Tampa,FL
17
years of professional experience
Professional claims specialist with strong focus on team collaboration and achieving results. Skilled in claims analysis, CSR,risk assessment, and conflict resolution, offering reliability and adaptability in dynamic environments. Known for effective communication, problem-solving abilities, and results-driven approach that consistently meets organizational goals.
Work History
Sr. Claims Associate
6 Years 7 Months- Analyzed insurance policies and claims forms to determine coverage levels, ensuring compliance with processing criteria and minimizing errors.
- Collaborated with claims department and external anti-fraud entities to adjudicate claims, verifying accurate provider coding and service to prevent fraudulent activities.
- Reviewed eligibility, coordination of benefits, and authorization requirements to ensure accurate claim decisions.
- Processed complex medical claims using claims adjudication systems and plan benefit guidelines.
- Communicated with providers and internal partners to clarify coding, benefits, and reimbursement questions.
- Escalated high-priority claims cases and coordinated timely resolution across operational teams.
Enrollment Specialist/Claims Specialist
10 Months- Determined patient eligibility for care and recommended programs or treatments, coordinating with insurance companies to verify coverage and expedite approval.
- Obtained and filed patient records and enrollment forms accurately, ensuring compliance with protocols and supporting efficient enrollment processes.
- Analyzed and processed medical claims accurately, ensuring compliance with company policies and regulatory standards to facilitate timely reimbursements.
- Managed employee benefits enrollment, verifying eligibility and plan selections for accuracy.
- Coordinated qualifying-event enrollments across medical, dental, vision, and voluntary benefits.
- Processed benefit changes, terminations, and dependent updates in compliance with carrier and plan rules.
- Updated, entered, and reviewed customer data.
- Communicated effectively via telephone, email, and in person with prospective customers.
- Understood and thoroughly explained services provided to customers and potential customers.
- Developed training materials for new Enrollment Specialists, enhancing departmental performance and consistency in processes.
Insurance Verification Specialist
2 Years 6 Months- Verified insurance benefits and completed patient administrative intakes, ensuring accuracy in case histories and insurance data to facilitate seamless patient care.
- Coordinated medical referrals and maintained detailed patient records while upholding compliance with HIPAA and other regulatory standards.
- Addressed customer inquiries and resolved issues related to health benefits, eligibility, and plan options, improving overall customer satisfaction.
- Reviewed insurance authorizations and referrals to support accurate patient access decisions.
- Resolved coverage discrepancies by coordinating with payers, providers, and billing teams.
- Documented verification results in electronic health records and account files with precision.
- Audited insurance information for accuracy, completeness, and compliance with HIPAA standards.
- Trained team members on verification workflows, documentation requirements, and payer communication.
- Assured timely verification of insurance benefits prior to patient procedures or appointments.
- Updated patient records with accurate, current insurance policy information.
- Made contact with insurance carriers to discuss policies and individual patient benefits.
Benefits Coordinator
1 Year 2 Months- Coordinated employee benefits programs, ensuring compliance with federal and state regulations while maintaining accurate records of enrollments, terminations, and plan changes to support smooth operations.
- Facilitated communication with staff on benefits options, improving understanding and utilization of available programs.
- Administered benefits enrollment, eligibility updates, and qualifying life event changes with consistent accuracy.
- Coordinated open enrollment communications, employee questions, and plan documentation across HR and vendor teams.
- Processed COBRA, FMLA, and leave-related benefits actions while maintaining compliant records.
- Reviewed benefit elections and deductions, resolving discrepancies between payroll, carriers, and employee files.
- Maintained HRIS benefit records, enrollment forms, and confidential documentation for audit readiness.
- Supported employees with medical, dental, vision, and retirement plan inquiries using clear, timely guidance.
- Collaborated with insurance carriers and third-party administrators to correct eligibility and coverage issues.
- Improved benefits workflows by tracking issues, standardizing updates, and reducing administrative delays.
- Explained benefits to plan participants in easy to understand terms in order to educate each on available options.
Customer Service Representative
2 Years 11 Months- Provided exceptional customer support, addressing inquiries and resolving issues to enhance service satisfaction.
- Maintained compliance with company policies and procedures while prioritizing customer needs.
- Resolved customer inquiries about wireless service, billing, and device support.
- Guided customers through plan changes, upgrades, and account adjustments.
- Documented interactions accurately in CRM systems and account notes.
- De-escalated complaints using problem-solving and conflict resolution techniques.
- Explained promotions, product features, and service options clearly.
- Processed payments, returns, and order changes with accuracy.
- Improved customer retention through timely follow-up and personalized support.
- Managed high-stress situations effectively, maintaining professionalism under pressure while resolving disputes or conflicts.
- Resolved customer complaints with empathy, resulting in increased loyalty and repeat business.
Education
High School Diploma - General Education
Skills
Claims analysis
Eligibility assessment
Claims Communication
Settlement Negotiation
Coverage Determination
Claims Investigation
Settlement negotiation
Account follow-up
Customer Relations
Coverage Determination
Billing practices
Billing Processing
Team Performance
Information Updates
Claim Documentation
Claims Investigation
Adaptability
Multitasking
Provider Enrollment
Verification Specialist
Long Term Disability Claims Specialist
Customer Account Management
Facets
Proficiency in Microsoft Excel
Communication Skills
Time Management
Knowledge of Insurance Policies
EOB
Microsoft Office
Claims Processing
Timeline
Sr. Claims Associate
Elevance Health
01.2020 - 08.2026Read More
Enrollment Specialist/Claims Specialist
Continental Benefits
02.2018 - 12.2018Read More
Insurance Verification Specialist
HealthPlan Services
05.2015 - 11.2017Read More
Benefits Coordinator
Care Media Inc
01.2014 - 03.2015Read More
Customer Service Representative
Verizon Communications Inc
02.2010 - 01.2013Read More
Gary Adult Center
High School Diploma from General Education
Read More