Thomas Gilbreath
Austin
Summary
Dynamic Claims Adjustment Specialist with proven expertise at Bay Bridge Administrators in claims analysis and adjudication. Skilled in policy interpretation and compassionate communication, I excel in resolving complex claims efficiently, ensuring compliance with regulations, and enhancing customer satisfaction. Recognized for my problem-solving abilities and meticulous attention to detail in high-pressure environments.
Overview
11
11
years of professional experience
Work History
Claims Adjustment Specialist
Bay Bridge Administrators
Austin
03.2022 - Current
- Analyzing, processing, researching, adjusting, auditing, and adjudicating claims which will result in a payment or non-payment of a claim with minimal guidance.
- Review insurance policies, the claim form and supporting documentation to make sure that all of the information is correct. They determine whether the claims are covered under the policies issued to that policyholder.
- Provide the insured with correspondence that is clear, concise and meets state regulations in relation to the decision they made on the claim processed.
- Assist in identifying, investigating and reporting fraudulent claim activity to our internal fraud unit.
- Provide customer service telephone support for benefit and claim inquiries
Claims Technician
Blue Cross Blue Shield
Abilene
07.2018 - Current
- Responsible for processing complex claims requiring further investigation and resolving pended claims.
- Review and compare information in computer systems and apply proper codes/documentation.
- Place outgoing calls to providers and/or pharmacies for further investigation before processing claims.
Processing Technician
CSL Plasma
Abilene
11.2017 - 07.2018
- In compliance with Standard Operating Procedures (SOPs), responsible for collecting plasma samples and moving plasma units to freezer to ensure product quality.
- Ensured plasma units are properly stored according to SOPs, which could include unsuitable plasma units and samples.
- Ensured accuracy of unit labeling by verifying the pre-printed label matches the dynamic label.
- Utilized sterile technique to draw samples and uses heat sealer to assure the sterility and quality of plasma unit samples per SOPs.
- Ensured samples and units are packed and shipped in accordance with SOPs and center procedures. Prepares shipping and unit disposal documentation.
- Monitored freezer and refrigerator temperatures and immediately informs appropriate personnel if equipment is not functioning properly. Records variances.
- Conducted daily calibration of equipment according to SOPs.
- Ensured the accurate recording of donor data in the electronic donor information management system as outlined in the SOPs.
- Maintained clean efficient work environment, and ensured sufficient operating supplies and forms were available as needed. Followed all Health Safety & Environmental (HSE) and Occupational Safety and Health Administration (OSHA) policies and procedures.
Grocery Associate
Sam's Club
Abilene
02.2017 - 07.2017
- Responsible for maintaining immaculate appearance of aisles, assisting customers, keeping items stocked, and answering phone calls.
Salesman
SCHWANS
Abilene
11.2015 - 05.2016
- Responsible for maintaining a route, greeting customers, selling product off of the truck, and filling out paperwork.
Pest Control Technician
Orkin Pest Control
Abilene
04.2015 - 11.2015
- Responsible for maintaining a route, mixing chemicals properly, treating customers homes, and inspecting customers homes.
Education
Associate in Science -
CISCO JUNIOR COLLEGE
Abilene, TX05.2018
N/A - Biology
HARDIN SIMMONS UNIVERSITY
Abilene, TXN/A - Biology
TEXAS TECH UNIVERSITY
Lubbock, TXN/A - Biology
McMurry University
Abilene, TXSkills
- Microsoft Office Suite
- Data management
- Microscopy techniques
- Field and laboratory expertise
- Driving proficiency
- Claims analysis and adjudication
- Policy interpretation
- Claims processing and auditing
- Compassionate communication
- Customer feedback management
- Time management
- Problem solving
- Multitasking capacity
- Conflict management
Additional Information
I am seeking a rewarding career utilizing my background of education and lab experience. The ideal career would offer an opportunity to help improve the quality of the city I live in. Furthermore, the position would allow for continued growth and development while impacting the world around me.
References
- Professional, Terrence Boyle, Assistant Professor of Biology, McMurry University, 979-450-8005, Abilene, TX
- Professional, Brett Baucum, Claims Technician, Blue Cross Blue Shield, 325-370-4555, Abilene, TX
- Personal, William Miller, Engineer, 325-277-0684, Sweetwater, TX
Personal Information
Authorized To Work: US
Timeline
Claims Adjustment Specialist
Bay Bridge Administrators
03.2022 - Current
Claims Technician
Blue Cross Blue Shield
07.2018 - Current
Processing Technician
CSL Plasma
11.2017 - 07.2018
Grocery Associate
Sam's Club
02.2017 - 07.2017
Salesman
SCHWANS
11.2015 - 05.2016
Pest Control Technician
Orkin Pest Control
04.2015 - 11.2015
Associate in Science -
CISCO JUNIOR COLLEGE
N/A - Biology
HARDIN SIMMONS UNIVERSITY
N/A - Biology
TEXAS TECH UNIVERSITY
N/A - Biology
McMurry University