Terry Hunter
Columbus,GA
Summary
Seasoned Healthcare Insurance Professional with 10+ years experience specializing in Customer Service and Claims Specialist. Committed to strong professional accountability with proven records of high quality standards. Skilled at building rapport with subscribers and providers to optimize information exchanged to ensure the rapid resolution of inquiries.Motivated to maintain customer satisfaction and contribute to company success. .
Overview
34
34
years of professional experience
Work History
Customer Service Representative /Claims Representative
Elevance Health
03.1992 - 12.2025
- Experienced healthcare professional with a background in ensuring HIPAA compliance, maintaining patient data is secure.
- Customer Service and Claims Processor consistently maintained a 99% quality rate and 100% production rate on internal performance audits without direct supervision.
- Dedicated 10 hours additional hours weekly to resolve inquiry backlogs, restoring inventory to target levels.
- Resolved subscriber inquiries through effective communication and problem-solving techniques.
- Guided subscriber in navigating health insurance options to ensure informed decisions.
- Educated subscribers on complex insurance liabilities, including deductibles, co-pays,co-insurance, and annual out of pocket maximums.
- Proficient in the application of ICD 10 procedure and ICD-10-CM diagnosis coding.
- Managed high-stress situations effectively, maintaining professionalism under pressure while resolving disputes.
- Maintained detailed records of subscriber interactions, ensuring proper follow-up and resolution of issues.
- Facilitated time sensitive prior authorization and pre-certification to ensure seamless access to medial care.
- Streamlined the resolution of billing inquires by accurately processing complex adjustments and refunds.
- Interpreted and posted insurance payments from Explanation of Benefits (EOBs) with 100% accuracy, ensuring precise reconciliation of the insurance claim process.
- Secured precise reimbursement by accurately processing professional CMS-1500 claim forms ensuring adherence to payer specific guidelines.
- Coordination of Benefits, analyzed and reconciled conflicting member primary and secondary payer liability. Medicare Part A , B and D also verified eligibility and benefit periods. maenrollment files to eliminate duplicate claim payouts
Education
Shaw High School
Columbus,GeorgiaSkills
- Customer Service
- Claims Processor-Data Entry-Follow Up
- Claims Adjustment Specialist
- Payment Posting from Explanation of Benefits
- Insurance Verification
- Coordination of Benefits Research
- Medical Coding
Timeline
Customer Service Representative /Claims Representative
Elevance Health
03.1992 - 12.2025
Shaw High School