Troiniece Austin
Houston,TX
Summary
Results-oriented professional with a strong track record of collaborating effectively within diverse teams to achieve shared goals. Demonstrated ability to thrive in fast-paced environments while maintaining a positive and proactive attitude. Skilled in leveraging excellent communication and interpersonal skills to foster productive relationships and drive team success. Committed to delivering high-quality work and exceeding expectations through strong problem-solving abilities and a dedication to continuous learning and growth.
Overview
9
9
years of professional experience
Work History
Claims Representative
Gainwell Technologies
02.2022 - 04.2024
- Provided quality customer service to assigned, insured and claimants throughout claims process to deliver timely service to customers.
- Verified details with policyholders and requested additional information.
- Delivered quality customer service to assigned, insured and claimants throughout entire claims lifecycle to promote service times.
- Reviewed documentation and accounts to gain full picture.
- Assisted claimants, providers and clients with problems or questions regarding claims.
- Documented changes in claim statuses using specialized software systems.
- Collaborated with other departments to resolve billing disputes or address customer concerns quickly.
Data Entry Clerk
Healthplan one
09.2020 - 10.2021
- Ensured compliance with all relevant rules and regulations governing data entry activities.
- Utilized specialized software applications related to the job role.
- Collaborated with other departments to resolve issues regarding incorrect data entries.
- Prepared summaries of daily work completed for review by supervisors.
- Organized files according to established procedures for easy retrieval later on.
Medical Claims Representative
Diversicare Health Care
09.2018 - 07.2020
- Maintained knowledge of benefits claim processing, claims principles, medical terminology and procedures and HIPAA regulations
- Managed large volume of medical claims on daily basis
- Paid or denied medical claims based upon established claims processing criteria
- Responded to correspondence from insurance companies
- Used administrative guidelines as resource or to answer questions when processing medical claims
- Reviewed provider coding information to report services
Participant Services Associate
Ascensus
11.2015 - 09.2018
- Provide expertise or general claims support by reviewing
- Researching
- Investigating
- Negotiating
- Processing and adjusting claims
- Answering questions regarding pre-tax spending accounts, such as health and dependent care Flexible
- Spending Accounts (FSA), as well as Commuter Benefit Services, including transit and parking programs,
- Health Savings Accounts, & Health Reimbursement Arrangements
- Analytical skills in reviewing and interpreting policy coverage and claims status
Quality Control Specialist
Gainwell Technologies of Wisconsin
02.2022 - Current
Education
Some College (No Degree) - Nursing Assistance
Houston Community College
Houston, TXHigh School Diploma -
Stratford High School
Houston, TX05-2012
Skills
- Claims
- Interpersonal Communication
- Decision Making
- Documentation Research
- Policy Knowledge
- Claims Investigation
- Database Management
- Data Analysis
- Insurance Claims Review
- Small Claims Payouts
- Customer Service
- Insurance Claim Forms Review
- Microsoft Office
- Payment and Investigation Escalations
- ICD-10 Coding
- Computer Skills
- HIPAA Compliance
- Problem-Solving
- OSHA Compliance
- Data Entry Software
- Equipment Troubleshooting and Maintenance
- Epic Systems
- Customer service
- Typing
- JavaScript Expert
- Good Work Ethic
- Zendesk
- Microsoft outlook
- Information verification
- Communication skills
- Fraud
- HRIS (5) years
- Data Validation
- Data transcription
- Data Security
- Filing and data archiving
- Data accuracy
- Error identification
- Advanced clerical knowledge
- Collecting information
Accomplishments
- Used Microsoft Excel to develop inventory tracking spreadsheets.
Timeline
Claims Representative
Gainwell Technologies
02.2022 - 04.2024
Quality Control Specialist
Gainwell Technologies of Wisconsin
02.2022 - Current
Data Entry Clerk
Healthplan one
09.2020 - 10.2021
Medical Claims Representative
Diversicare Health Care
09.2018 - 07.2020
Participant Services Associate
Ascensus
11.2015 - 09.2018
Some College (No Degree) - Nursing Assistance
Houston Community College
High School Diploma -
Stratford High School
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