Tiara Drakeford
Columbus,Oh
Summary
Excitedly seeking Claims Adjuster role to leverage analytical skills and attention to detail in assessing and resolving claims with precision. Experienced in quality control, proficient in Microsoft Office, and adept at editing and proofing documentation to ensure compliance and accuracy.
Overview
8
8
years of professional experience
Work History
Patient Service Representative
Central Primary Care Sport Spine & Joint
Westerville, OH
09.2025 - Current
- Managed patient scheduling and appointment coordination to optimize clinic efficiency.
- Conducted patient check-in processes, ensuring accurate documentation and compliance with protocols.
- Assisted in insurance verification and benefits explanation to streamline patient onboarding in Epic systems.
- Increased overall practice revenue by diligently collecting copayments and outstanding balances at the time of service.
- Handled complex insurance pre-authorization processes accurately, enabling timely delivery of necessary medical services.
E-Commerce Clerk
Kroger
Columbus, OH
05.2024 - Current
- Managed online customer orders by accurately selecting fresh grocery items from the store floor, ensuring timely and efficient processing of e-commerce transactions, and providing exceptional service for Kroger digital shoppers.
Sales Associate
Finish Line - JD Sports
Columbus, OH
01.2018 - 06.2024
- Collaborated with team members to meet sales goals and maintained a positive store atmosphere.
- Managed inventory levels, executed restocking duties, and upheld store cleanliness standards.
- Prioritized and executed tasks effectively to sustain productivity during peak hours.
Remote Claims Specialist
Gainwell Technologies LLC
Columbus, Ohio
01.2022 - 01.2023
- Analyzed policy information, assessed damages, and resolved claims, ensuring adherence to settlement guidelines.
- Escalated complex claims issues in accordance with company protocols and contributed to Medicaid/Medicare recovery efforts in compliance with state laws.
- Maintained current knowledge of insurance regulations and industry trends to support continuous professional development and effective case management.
PUA Intermittent Adjudicator Remote
Ohio JFS
Columbus, Ohio
01.2020 - 01.2022
- Analyzed and verified applicant eligibility for government assistance, ensuring thorough examination of criminal history, immigration, and citizenship status.
- Authorized and processed payments for valid claims, maintaining compliance with government assistance policies.
- Provided clear explanations to claimants regarding rulings and outlined the appeals process for additional clarity.
Hybrid Appeals & Grievance Specialist
Trinity Health
Columbus, Ohio
01.2018 - 01.2020
- Analyzed grievance and appeal cases to collect pertinent information and assess evidence, ensuring unbiased and judicious resolutions.
- Delivered timely and precise responses to resolutions, adhering strictly to Center for Medicare and Medicaid Services (CMS) regulations.
- Managed pre-certification processes, secured authorization numbers, and accurately recorded medical codes into patient accounts.
Education
High School Graduate -
East High School
Columbus, OH06.2012
Skills
- Analysis
- Customer Service
- Data Entry
- Proficient in Microsoft
- Detail Orientation
- Leadership
- Multi-Tasking
- Sales / Promotions
- Teamwork
- Time Management
- Problem-Solving
- Written & Verbal Communication
- Attention to Detail
- Critical Thinking
- Microsoft Office Proficiency
- Insurance Policy Knowledge
- Communication Skills
- Strong Proficiency
- Organize
- Manage Priorities
- Problem Resolution
Timeline
Patient Service Representative
Central Primary Care Sport Spine & Joint
09.2025 - Current
E-Commerce Clerk
Kroger
05.2024 - Current
Remote Claims Specialist
Gainwell Technologies LLC
01.2022 - 01.2023
PUA Intermittent Adjudicator Remote
Ohio JFS
01.2020 - 01.2022
Sales Associate
Finish Line - JD Sports
01.2018 - 06.2024
Hybrid Appeals & Grievance Specialist
Trinity Health
01.2018 - 01.2020
High School Graduate -
East High School