Tyesha Self
Greensburg,LA
Summary
Dynamic Claims Specialist with proven expertise at Cencora in policy interpretation and claims investigation. Enhanced customer satisfaction through effective decision-making and active listening, resulting in increased client retention. Demonstrated strong attention to detail while ensuring compliance with industry regulations, contributing to a significant reduction in claim processing time.
Overview
8
8
years of professional experience
Work History
Claim Specialist
Cencora
01.2022 - Current
- Reviewed and maintained accurate claim files, ensuring all necessary documentation was in place for future reference.
- Maintained compliance with industry regulations by staying up-to-date on changes in policies and procedures, ensuring proper handling of sensitive information.
- Conducted thorough investigations into insurance claims to determine coverage eligibility and appropriate compensation amounts.
- Enhanced customer satisfaction with prompt and accurate claim resolutions, resulting in positive feedback and increased client retention.
- Provided exceptional customer service during difficult situations, displaying empathy while explaining complex claim issues clearly to clients.
- Managed high-volume caseloads effectively, prioritizing urgent cases while maintaining attention to detail for all claims.
Claims Representative
Spectraforce
05.2018 - 02.2022
- Worked productively in fast-moving work environment to process large volumes of claims.
- Followed up with customers on unresolved issues.
- Improved customer satisfaction by providing timely and accurate information on claim status and resolution.
- Maintained compliance with industry regulations by adhering to established procedures and guidelines in claims handling.
- Developed strong relationships with clients, facilitating trust and open communication during the claims process.
- Minimized financial losses by identifying fraudulent claims through thorough analysis and investigation.
Fax Reviewer
Dupixent
04.2017 - 01.2022
- Maintained strong attention to detail while reviewing numerous documents daily, ensuring consistent quality and accuracy.
- Maintained strict confidentiality with sensitive client information, adhering to industry standards and company policies.
- Reduced turnaround time for reviews by effectively prioritizing tasks and managing deadlines.
- Contributed to the development of a knowledge base for common issues encountered during reviews, streamlining future problem-solving efforts.
- Supported continuous improvement initiatives by actively participating in team meetings, trainings, and workshops focused on enhancing reviewer skills and processes.
- Ensured consistency across multiple review projects by maintaining strict adherence to established protocols and procedures.
Education
Associate of Science - Healthcare Management
Ultimate Medical Academy
Clearwater, FL09-2024
High School Diploma -
St. Helena Central High
Greensburg, LA05-2013
Skills
- Policy interpretation
- Legal compliance
- Financial acumen
- Claims investigation
- Decision-making
- Critical thinking
- Customer service
- Attention to detail
- Organizing and prioritizing work
- Active listening
Timeline
Claim Specialist
Cencora
01.2022 - Current
Claims Representative
Spectraforce
05.2018 - 02.2022
Fax Reviewer
Dupixent
04.2017 - 01.2022
Associate of Science - Healthcare Management
Ultimate Medical Academy
High School Diploma -
St. Helena Central High
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