Toi Singleton
Baton Rouge,La
Summary
Experienced Claims Specialist with a proven track record of driving organizational success through strategic thinking and operational excellence. Skilled in fostering collaboration across departments and implementing innovative solutions to complex challenges in high-pressure environments. Adept at navigating high-stakes situations and delivering results that positively impact the bottom line. Passionate about contributing to the continued growth and success of a dynamic organization.
Overview
13
13
years of professional experience
Work History
Account Advisor I
Blue Cross Blue Shield of Louisiana
12.2024 - Current
- Review and research billing and healthcare claim inquiries from members and providers, to ensure proper benefits and/or payments are applied correctly; research multiple computer systems/applications to verify data/information accuracy.
- Identified and resolved complex customer disputes in a timely manner, maintaining 90% customer satisfaction.
- Respond to inquiries regarding adjustments, refunds, edits, and or payment registers to ensure completeness.
- Closed out claims to bill patient for correct insurance or to update coordination of benefits.
- Verified pricing and prior authorizations, maintain current knowledge of billing coding, cpt, HCPCS. Revenue Codes and proper use of modifiers
- Maintained strict confidentiality in accordance with HIPAA regulation and company policies.
Benefits Representative
Conduent
11.2022 - 07.2024
- Service consumers inbound inquires via phone regarding HRA, FSA, DCFSA, and HSA accounts.
- Assisting with open enrollment process.
- Developing and maintaining important company wellness programs and initiatives.
- Investigate all claims and cases within timely information transmission while maintaining compliance with the set standards to support the company goals and ensure overall productivity.
Unemployment Claims Specialist
Alorica
10.2012 - 12.2021
- Examine and maintained a wide range of unemployment compensation accounts, cases, and applications. Responded to multiple customer claim inquiries from variety sources.
- Promoted to adjudicator for adjudication of unemployment claims involving eligibility of unemployment benefits for disputed (protested) claims.
- Reviewed unemployment claims against program eligibility requirements by comparing claims to state and federal guidelines regarding the program.
- Coded and processed claims for payment ensuring all necessary information is provided and contract benefits are applied accurately for Unemployment Compensation and PUA benefits.
- Closed all claims investigations with timely information transmission while maintaining compliance with the set standards to support the company goals and ensure overall productivity.
Data Entry Clerk
Valence Health
09.2018 - 10.2019
- Utilize database and software systems to log information for at least 100 customers per day and ensure data is accurate and complete.
- Process large quantities of data by using excellent typing skills.
- Complete all assigned data entry requests and tasks within required timeframes while maintaining a high-level of quality.
- Conducted secure follow-up phone call and emails to acquire classification on missing erroneous data from the client.
Education
BA - Human Resource Management
Virginia College
Mobile, Alabama05.2013
Associate - Medical Billing
American Academy of Professional Coders
Salt Lake, Utah05.2024
Skills
- Claims administration
- ICD-10 coding expertise
- Knowledgeable in healthcare terminology
- Understanding of HIPAA regulations
- Administration of reimbursement guidelines
- EHR/EMR management
- Appeals process coordination
- Experience with insurance plan management
- Effective communication
- Skilled in healthcare reimbursement systems
- Healthcare terminology proficiency
Timeline
Account Advisor I
Blue Cross Blue Shield of Louisiana
12.2024 - Current
Benefits Representative
Conduent
11.2022 - 07.2024
Data Entry Clerk
Valence Health
09.2018 - 10.2019
Unemployment Claims Specialist
Alorica
10.2012 - 12.2021
Associate - Medical Billing
American Academy of Professional Coders
BA - Human Resource Management
Virginia College
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