Valincia Harris
Lakemoor,IL
Summary
Claims Examiner with deep knowledge of medical claims industry. Solid abilities in developing objectives and strategies to settle medical claims. Excellent skills compiling, coding, categorizing and auditing information to process claims.
Overview
8
8
years of professional experience
Work History
Claims Examiner
Sedgwick Claims Management
09.2023 - Current
- Provided exceptional customer service by empathetically addressing claimants'' concerns and effectively explaining the claims process to them.
- Consulted police and hospital records when needed.
- Achieved streamlined communication between departments by collaborating closely with underwriters, agents, and other stakeholders throughout the claims handling process.
- Utilized analytical skills to evaluate medical bills for accuracy and appropriateness of charges before approving payments as part of the claims process.
- Managed caseloads effectively while maintaining high-quality work standards and meeting strict deadlines consistently.
- Directed claims negotiations and supported successful litigations for advanced issues.
Data Specialist
K-12 Online
04.2022 - 10.2022
- Validated incoming data against quality standards to eliminate irrelevant or unusable information.
- Scanned documents and saved in database to keep records of essential organizational information.
- Supported operations staff in researching data configuration and processing issues.
- Reviewed and updated client correspondence files and database information to maintain accurate records.
- Update demographics and other membership information from paper correspondence and telephone call documentation.
- Make outbound calls to members to clarify missing or incomplete information.
- Analyzed large volumes of raw data to identify trends, patterns, and insights that informed strategic planning initiatives.
Personal Health Care Assistant
Department Of Rehabilitation Services
09.2016 - 09.2021
- Provided compassionate and patient-focused care to cultivate well-being.
- Assisted clients with daily living needs to maintain self-esteem and general wellness.
- Recorded patients' pulse, blood pressure and respirations (TPRs) to assess and document important health information.
- Handled incoming mail, bills and invoices and completed appropriate actions.
- Communicated with insurance companies to obtain pre-authorizations for treatment.
- Evaluated patient histories, complaints, and current symptoms.
- Completed data entry tasks with accuracy and efficiency.
- Organized, sorted, and checked input data against original documents.
Education
High School Diploma -
Marshall High School
Skills
- Word Processing
- Health Programs
- Office Cleaning
- Cash Register Operations
- Medical Terminology
- EMR
- Type 58WPM
- Data Entry
Timeline
Claims Examiner
Sedgwick Claims Management
09.2023 - Current
Data Specialist
K-12 Online
04.2022 - 10.2022
Personal Health Care Assistant
Department Of Rehabilitation Services
09.2016 - 09.2021
High School Diploma -
Marshall High School
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