TEZRA PALMER
Florence,SC
Summary
Experienced Claims Processor and Customer Service Specialist with expertise in medical claims, data entry, and client support. Skilled in high-volume claims management, resolving billing issues, and ensuring accuracy while delivering exceptional service in fast-paced healthcare and insurance settings.
Overview
13
13
years of professional experience
Work History
Correspondence Specialist II
Centene
09.2026 - Current
- Composed letters and electronic correspondence for professionals and management team.
- Edited written responses for tone, clarity, and compliance
- Managed incoming correspondence for employer communications teams
- Tracked correspondence status in document management systems
Medical Claims Processor/Senior Claim Processing Specialist
United Healthcare
03.2023 - Current
- Accurately process and adjudicate medical claims according to company policies and healthcare regulations.
- Review medical documentation and coding (ICD-10, CPT, HCPCS) to validate claims and ensure compliance with plan benefits.
- Investigate and resolve claim discrepancies by collaborating with internal departments and external providers.
- Perform high-volume data entry, ensuring the correct input of member, provider, and claims information into internal systems.
- Meet daily production and quality targets while upholding accuracy in all claim-related transactions.
- Utilize multiple systems and databases to retrieve patient records and update claims statuses efficiently.
- Modified and updated existing policies and claims to reflect change in beneficiary, amount of coverage or type of insurance.
- Coordinated with healthcare providers to obtain missing information or clarification on claims.
- Communicated effectively with policyholders, providing updates and explaining the claims process clearly.
- Handle escalated or complex claims requiring additional research and review of medical necessity.
- Collected payments, processed receipts and informed policyholders of outstanding balances.
- Conducted remote claims processing to maintain workflow and meet production goals. to manage claims processing efficiently.
Short Term Disability Analyst
Cielo
01.2022 - 01.2023
- Managed short-term disability claims by gathering and reviewing employee medical documentation to assess eligibility.
- Maintained accurate case files and ensured timely data entry of confidential medical and employment information to support effective claims management.
- Facilitated claims processing and resolved inquiries by communicating with employees, healthcare providers, and HR teams, enhancing overall claim experience.
- Maintained accurate case files and performed timely data entry of confidential medical and employment information.
- Coordinated with internal teams to ensure compliance with company policies and applicable regulations.
- Monitored claim timelines to ensure adherence to service level agreements (SLAs) and minimize processing delays.
- Monitored claim timelines to ensure compliance with service level agreements (SLAs), reducing processing delays and improving service delivery.
- Assisted in compiling reports and summaries for management regarding claim trends and resolution outcomes.
Senior Claim Benefit Specialist
Lead Point
01.2019 - 01.2021
- Executed quality checks on claims by junior processors, ensuring compliance with health plan guidelines and enhancing overall accuracy.
- Conducted comprehensive reviews of medical codes, provider contracts, and explanations of benefits (EOB) to validate claims effectively.
- Facilitated appeals and reconsideration requests by compiling necessary documentation and providing formal responses to stakeholders.
- Collected necessary documents for appeals and reconsiderations at the request of stakeholders.
- Maintained precise and detailed records within claims processing systems, ensuring HIPAA compliance.
- Worked closely with cross-functional teams, including underwriting and customer service, to resolve claim discrepancies.
- Worked closely with cross-functional teams, including underwriting and customer service, to resolve claim discrepancies.
Claims Processor Specialist
Travel Center Of America
01.2014 - 01.2019
- Reviewed and processed insurance claims to ensure accurate and timely resolution.
- Investigated and resolved claim issues, including incorrect coding, missing information, and provider disputes, enhancing accuracy in claims processing.
- Investigated claim issues, such as incorrect coding, missing information, or provider disputes, and resolved them efficiently.
- Assisted claimants, providers and clients with problems or questions regarding claims.
- Reviewed and processed insurance claims, ensuring accuracy and timely resolutions to support client satisfaction.
- Monitored aging reports and followed up on outstanding claims, facilitating timely processing and minimizing delays.
- Supported the implementation of new claims software by participating in user testing and feedback sessions.
Education
Diploma -
Latta High School
Latta, SCSkills
- Claim processing
- Claims handling
- Claims compliance
- Claims assessment
- Claim analysis
- Claims evaluation
- Document processing
- Data entry proficiency
- Attention to detail
- Regulatory compliance
- HIPAA Compliance
- Coverage verification
- Letter writing
Personal Information
Title: CLAIMS | CUSTOMER SERVICE
Timeline
Correspondence Specialist II
Centene
09.2026 - Current
Medical Claims Processor/Senior Claim Processing Specialist
United Healthcare
03.2023 - Current
Short Term Disability Analyst
Cielo
01.2022 - 01.2023
Senior Claim Benefit Specialist
Lead Point
01.2019 - 01.2021
Claims Processor Specialist
Travel Center Of America
01.2014 - 01.2019
Diploma -
Latta High School