Summary
Overview
Work History
Education
Skills
Timeline
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Tequila Chasten

Goldsboro,NC

Summary

Highly motivated and driven Customer Service Rep seeking a challenging position to utilize my expertise in driving operational excellence, implementing process improvements, and maximizing revenue. Demonstrating a proven track record of success, I am dedicated to delivering exceptional results through active collaboration and strategic planning. Possessing exceptional communication and analytical skills, I excel at identifying growth opportunities and implementing effective solutions that optimize revenue while minimizing costs.

Overview

9
9
years of professional experience

Work History

Claims Specialist

Knowtion Health
06.2023 - Current
  • Processed payments: Handled payments for low to moderately complex claims, ensuring accuracy and timeliness
  • Utilized Artiva, Cerner & Epic to access patients accounts
  • Collaborated with internal resources: Worked closely with internal teams and colleagues to facilitate claims resolution, enhancing efficiency and customer satisfaction
  • Contributed to business goals: Played an active role in achieving organizational objectives by meeting performance metrics and leveraging tools and technology effectively

Medical Claims Specialist

UNC Healthcare
04.2022 - 10.2022
  • Processed and evaluated insurance claims for accuracy and completeness
  • Conducted thorough investigations to verify claim information and filed appeals for denied claims with proper documentation
  • Communicated effectively with policyholders, adjusters, and legal representatives to resolve claim disputes
  • Maintained a 98% accuracy rate in claims processing and consistently met or exceeded monthly processing targets
  • Delivered exceptional customer service to every customer by leveraging extensive knowledge of products and services and creating welcoming, positive experiences
  • Followed up with customers about resolved issues to maintain high standards of customer service

Customer Service Representative

Wayne UNC Health Care
02.2019 - 07.2021
  • Advised and educated patients on financial assistance programs, ensuring their understanding of available options and eligibility criteria
  • Developed and implemented efficient procedures for verifying insurance coverage, resulting in decreased claim denials and increased revenue for the healthcare facility
  • Adhered to company policies and scripts to consistently achieve call-time and quality standards.
  • Actively listened to customers, handled concerns quickly and escalated major issues to supervisor.
  • Documented and detailed calls and complaints using call center's CRM database.

Customer Service Representative

Hood Insurance
01.2016 - 01.2019
  • Investigated and assessed insurance claims to determine coverage, liability, and settlement amounts, utilizing analytical skills and attention to detail
  • Negotiated and settled claims with insured individuals and third-party claimants, effectively communicating complex information and resolving conflicts in a fair and diplomatic manner
  • Collaborated with a team of experts including lawyers, medical professionals, and engineers to gather evidence, evaluate damages, and provide accurate and timely claim resolutions
  • Prepared itemized statements, bills, or invoices and recorded amounts due for items purchased or services rendered.

Education

James Kenan High School

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Chronicals Billing School
12.2018

Skills

  • Accident Investigations
  • Compliance Management
  • Documentation Review
  • Coverage assessments
  • Data Collection
  • Call Management

Timeline

Claims Specialist

Knowtion Health
06.2023 - Current

Medical Claims Specialist

UNC Healthcare
04.2022 - 10.2022

Customer Service Representative

Wayne UNC Health Care
02.2019 - 07.2021

Customer Service Representative

Hood Insurance
01.2016 - 01.2019

James Kenan High School

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Chronicals Billing School

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Tequila Chasten