Tressa White

Reviewing, evaluating, and processing insurance claims to determine eligibility and payment. Also, ensuring that claims comply with company policies and regulatory guidelines while maintaining accuracy and efficiency in claim adjudication.

• Investigate claims by gathering necessary documents, medical records, or supporting evidence.

• Communicate with policyholders, healthcare providers, and other stakeholders to resolve discrepancies.

• Process approved claims and coordinate payments to policyholders or service providers.

• Identify and flag potentially fraudulent claims for further investigation.

• Maintain detailed records of claims processed and update system databases accordingly.

• Ensure compliance with industry regulations, company policies, and confidentiality requirements.

• Provide excellent customer service and assist claimants with inquiries regarding claim status and requirements.

• Verified and corrected errors in data to ensure high-quality records

• Managed databases, performed data cleaning, and ensured timely updates

• Assisted with report generation and data analysis tasks

•Assess and determine client eligibility for benefits and services by reviewing applications, financial documents, and supporting materials.

• Provide case management by maintaining detailed records, tracking client progress, and ensuring compliance with program policies.

• Explain complex eligibility requirements to clients in a clear and supportive manner, assisting with applications and documentation.

• Collaborate with social service agencies and community resources to connect clients with additional support.

• Ensure compliance with state and federal regulations by accurately documenting case actions and decisions.