Tenecha N. Dorsey
Rosedale,Maryland
Summary
My primary objective is to support the functioning of business operations and to ensure exceptional customer service. I aim to create a positive and productive work environment by communicating with team members. Claims Processor evaluating online entry, error correction and quality control review for final adjudication of claims. Strong business and financial acumen with proven success to maintain efficient operations. Extensive knowledge of billing, collections and fiduciary management.
Overview
27
27
years of professional experience
Work History
Claims Processor
United Health Care
07.2025 - Current
- Delivered accurate answers for benefits, eligibility, billing, payments, clinical authorizations, explanation of benefits, and behavioral health inquiries.
- Decreased repeat calls, messages, escalations, and provider dissatisfaction by resolving complex prior authorization and claim issues and executing next steps.
- Resolved provider concerns through accountable support across calls, chat, and email interactions.
- Improved contact routing by quickly triaging requests from physician offices, clinics, and billing offices.
- Enhanced cross-functional resolution through collaboration with internal partners and timely communication of updates to providers.
- Maintained efficiency across 30+ systems to retrieve information needed for issue resolution across multiple lines of business, provider types, and call types.
- Boosted adoption of self-service digital tools by guiding providers in navigation and highlighting benefits for quicker support.
- Guided providers in using self-service digital tools to assist with navigation questions.
Call Center/ Claims Representative- MD Medicaid Behavioral Health Team
Optum Healthcare
12.2020 - 07.2025
- Maximized one call resolution efforts while building sustainable relationships with participants and providers.
- Communicated and collaborated with members and providers to resolve issues using clear, simple language for better understanding.
- Review and research incoming behavioral healthcare claims from members and providers by navigating multiple computer systems.
- Ensured proper benefits were applied to each claim by following established claim processing policies and procedures, grievance procedures, state mandates, and CMS/Medicare guidelines.
- Completing problems resolution on behalf of the customer in real time or through immediate warm transfer to another department or resource.
- Ask appropriate questions and listen actively to identify specific questions or issues while documenting required information in computer systems.
- Answer 50+ incoming calls in a timely manner, while maintaining efficiency
- Documented all interactions in Incedo portal to maintain accurate records of conversations.
- Meeting the performance goals in efficiency, accuracy, quality, member satisfaction and attendance.
Contract: Customer Service Representative- MD Medicaid Behavioral Health Team
Protocall Services
07.2020 - 12.2020
- Answered inbound phone calls to assist customers with health care insurance options, ensuring clarity and understanding.
- Updated customer and account information to ensure accuracy and enhance service delivery.
- Addressed general customer inquiries to provide accurate information.
- Update case records and notate the purpose of the call.
- Utilize multiple database applications as resources.
- Welcomed feedback to enhance skills and performance.
- Striving to meet performance metrics to advance professional development and capabilities.
- Requirements of the Customer Representative Inbound
Administrative Assistant
Wilson Elser Moskowitz Edelman & Dicker
08.2018 - 03.2020
- As an office manager, I have honed my communication skills through years of experience in verbal and written communication with clients, vendors, and team members. I have extensive experience in creating and delivering presentations, preparing, and responding to business correspondence, and ensuring effective communication throughout the office. Managed large print and organization requests for attorneys and secretaries, ensuring timely completion of rush jobs and strict adherence to deadlines. Organized legal filings by pulling documents and bates labeling them for efficient retrieval. Prepared court forms. Document management and organization, saving to network, indexing for the file room. Set up the conference room for scheduled meetings, conferences, and depositions, facilitating smooth operations.
- Supported attorneys with legal calendars, hearings, and client meeting coordination.
- Prepared correspondence, pleadings, and litigation documents for Wilson Elser attorneys.
- Managed incoming calls, mail, and visitor requests for office operations.
Manager
Staples
12.2012 - 06.2017
- Directed Staples store operations, sales floor execution, and customer service standards.
- Monitored inventory levels and organized the stockroom to ensure product availability and efficient replenishment for Staples.
- Trained associates on merchandise placement, register procedures, and service expectations.
- Operated Xerox equipment to support daily operations, managing production of bulk projects for organizations and maintaining technology to ensure functionality.
Printing Specialist
Ricoh
07.2006 - 12.2012
- Operated Ricoh multifunction printers and copiers, ensuring timely completion of daily print production.
- Managed print queues and job tickets, prioritizing rush requests to meet client deadlines.
- Configured scan, copy, fax, and finishing settings for print jobs to optimize output quality.
- Maintained cleanliness and safety protocols in the workspace. Established and adjusted work procedures to meet production schedules. Mastered the intricacies of the process flow within each department.
Production Manager
Office Depot
08.2002 - 07.2006
- Managed print production schedules at Office Depot to optimize workflow.
- Tracked print orders and production deadlines to ensure timely completion.
- Managed team staffing, task assignments, and shift coverage.
- Oversaw daily activities of customer support teams to ensure operational efficiency. Designed and executed programs to enhance client satisfaction, leading to measurable improvements in service outcomes. Achieved team productivity merits and enhanced service quality by leveraging in-depth knowledge of company products and services.
Call Center/Client Services Representative
Sloman Sheild
11.1999 - 07.2002
- Educated customers and evaluated client security needs to tailor home automation security systems. Ensured client retention by providing peace of mind through tailored security solutions. Troubleshot client issues and provided resolutions to enhance satisfaction.
- Responded to client inquiries for Sloman Shield account service teams.
- Processed policy changes, endorsements, and renewal documents.
- Coordinated communication with carriers, underwriters, and clients.
Education
High School -
Catonsville High School
01-2001
Currently Attending - Medical Billing & Coding
Penn Foster
Skills
- Exceptional Client Satisfaction and Communicator skills
- Director of Projects
- Strong Multi-tasking and Problem-Solving abilities
- Proficiency in Microsoft Office Facets,Unet,Isset,Ique,Maccess,Linx
- Detail Oriented
- Claims adjudication
- Prior authorization
- Insurance procedures
- Benefits verification
- Claims research
- Problem solving
- Medical terminology
- Multitasking Abilities
- Claims processing
- Denied claims identification
- Team collaboration
Timeline
Claims Processor
United Health Care
07.2025 - Current
Call Center/ Claims Representative- MD Medicaid Behavioral Health Team
Optum Healthcare
12.2020 - 07.2025
Contract: Customer Service Representative- MD Medicaid Behavioral Health Team
Protocall Services
07.2020 - 12.2020
Administrative Assistant
Wilson Elser Moskowitz Edelman & Dicker
08.2018 - 03.2020
Manager
Staples
12.2012 - 06.2017
Printing Specialist
Ricoh
07.2006 - 12.2012
Production Manager
Office Depot
08.2002 - 07.2006
Call Center/Client Services Representative
Sloman Sheild
11.1999 - 07.2002
High School -
Catonsville High School
Currently Attending - Medical Billing & Coding
Penn Foster