Tierra Bell
Greensboro,NC
Summary
Claims Examiner with deep knowledge of healthcare claims industry. Solid abilities in developing objectives and strategies to settle healthcare claims. Excellent skills compiling, coding, categorizing and auditing information to process claims. Detail-oriented Examiner 5 years of experience. Strong command of conflict resolution and negotiation combined with excellent reporting and research skills. Thorough understanding of claims process.
Overview
6
6
years of professional experience
Work History
Claims Examiner
Sedgwick
2022.09 - Current
- Create and assist with claims regarding Family Medical Leave of Absence, Worker’s Compensation and Short-Term Disability
- Act as a liaison between customers and team members when necessary
- Analyzes and process complex or technically difficult claims by investigating and gathering information to determine the exposure of the claim
- Manages claims through a well-developed action plans to appropriate and timely resolution
- Ensure claim files are properly documented and claims coding is correct
- Assist with developing corrective/preventative actions.
- Handled sensitive information with discretion, ensuring confidentiality of personal and financial details for claimants throughout the claims examination process.
Claims Handler II
Unum
2022.01 - 2022.08
- Obtained necessary documents and forms from the claimants
- Achieved set targets in line with required quality standards
- Prepared required paperwork to make an accurate payment decision
- Managed multiple claims at a time while researching individual case history and claim details
- Assisted all parties with questions regarding claims by phone or written correspondence while providing exceptional customer service
- Maintained records, spreadsheets and task as assigned
- Demonstrated continual attention to detail judgment.
- Ran 25 special projects and initiatives at both local and regional level.
Member Service Advocate
Humana
2018.07 - 2020.01
- Multitask in a fast-paced environment while navigating between multiple computer applications to access member information and document calls
- Provide a positive experience to the members through active listening skills and effective communication
- Self-manage with minimal supervision while maintaining high quality
- Intakes details of inquiries, comments or grievances and acts in accordance with it
- Determine appropriate policy and procedure to utilize for resolution of Strong written & verbal communication skills
- Demonstrated ability to uphold core values of caring, inspiration, integrity, and excellence in each member’s interaction and in building team cohesiveness.
Education
Associate’s degree in Applied Science -
Virginia College
Greensboro, NC06.2016
Skills
- Microsoft Office Suite
- Attention to Detail
- Certified Claims Professional (CCP)
- Data Verification
- Client Interviewing
- Active Listening
- Claims Evaluation
- Decision-Making
- Case Presentation
Timeline
Claims Examiner
Sedgwick
2022.09 - Current
Claims Handler II
Unum
2022.01 - 2022.08
Member Service Advocate
Humana
2018.07 - 2020.01
Associate’s degree in Applied Science -
Virginia College
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