Valinda White
Morrow,Georgia
Summary
Results-driven Claims Advocate with expertise in claims processing and problem resolution. Resolves complex issues and enhances customer satisfaction through effective communication and collaboration. Maintains precise documentation and coding systems to improve operational efficiency in claims management.
Overview
15
15
years of professional experience
1
1
Certification
Work History
Claims Advocate
Included Health
Atlanta, GA
08.2024 - Current
- Reviewed and processed medical claims for accuracy and adherence to insurance policies, ensuring compliance and reducing claim rejections
- Investigated and resolved complex claim issues by analyzing medical records and billing information, leading to timely claim resolutions
- Collaborated with healthcare providers to obtain additional documentation or clarification on claim details
- Identified potentially fraudulent activities or billing errors through careful analysis of claims data
- Utilized coding systems such as CPT, ICD-10, HCPCS to accurately assign appropriate reimbursement codes for services rendered
- Communicated with insurance companies regarding claim status updates, denials, appeals, and payment discrepancies
- Ensured timely resolution of outstanding claims by following up with payers regularly
- Collaborated with billing specialists, physicians, and nurses to efficiently resolve complex claim issues, enhancing interdepartmental communication
Auto Insurance Specialist
USAA Auto Claim
Atlanta, GA
11.2017 - 07.2024
- Reviewed and processed insurance claims ensuring accuracy, completeness, and compliance with company policies to facilitate timely resolutions.
- Investigated claim documents, including medical records and police reports, to determine coverage eligibility.
- Clarified claim details and gathered additional information by communicating effectively with policyholders and legal representatives, enhancing claim understanding.
- Closed sales on new policies by presenting insurance options to customers accurately and efficiently.
- Collaborated with carriers to resolve discrepancies in insurance payments.
- Evaluated claims against policy terms, making settlement decisions within established authority limits.
- Identified potential fraudulent claims through investigations and collaboration with fraud detection units.
- Negotiated settlements by evaluating liability and damages incurred by policyholders, resulting in fair compensation agreements.
- Maintained accurate documentation of all claim activities in accordance with regulatory requirements.
- Participated in ongoing training to remain informed on changes in insurance laws and industry practices.
Part-Time Tax Preparer
TaxSlayer
Atlanta, GA
01.2013 - 05.2018
- Prepared and filed accurate federal, state, and local tax returns for multiple entities.
- Prepared individual and business tax returns using TaxSlayer software.
- Guided clients in effectively responding to IRS notices of deficiency or audit findings.
- Researched complex tax regulations to advise clients on deductions, credits, and exemptions.
- Analyzed financial records to identify tax savings opportunities and recommend strategies.
- Audited tax forms for errors to minimize audit risks and penalties.
- Utilized electronic filing systems for efficient, accurate data submission.
- Demonstrated attention to detail in reviewing complex financial documents.
Customer Service Sales Representative
UnitedHealthcare
Atlanta, GA
06.2014 - 09.2017
- Answered incoming customer calls regarding product questions, sales inquiries, and complaints.
- Fielded inbound calls, addressing customer needs regarding medication, appointments, and benefits.
- Recommended additional products or services tailored to customer needs, enhancing overall customer experience.
- Identified potential opportunities to upsell products or services.
- Demonstrated products, successfully capturing sales by addressing objections through effective communication.
- Conducted follow-up calls to ensure customer satisfaction with products or services, reinforcing customer loyalty.
- Processed payments for service fees and equipment rentals efficiently.
- Coordinated delivery to ensure customer satisfaction following payment processing.
- Handled stressful situations professionally while multitasking to maintain service quality.
- Assisted customers with UCard usage and online orders to enhance user experience.
Concierge Front Desk
Palms At Lake Spivey
Jonesboro, GA
09.2011 - 06.2014
- Greeted guests and addressed inquiries to ensure positive experiences.
- Welcomed visitors while providing information about services and amenities.
- Assisted guests with dining and recreational reservations to elevate their enjoyment.
- Coordinated transportation arrangements for guests to streamline arrivals and departures.
- Directed incoming calls and messages to appropriate staff or residents efficiently.
- Maintained updated concierge book to reflect relevant visitor information.
- Handled mail and package deliveries, ensuring security of items.
- Scheduled space and equipment for meetings, programs, and conferences.
Education
High School Diploma -
Andrews High
Andrews, SC06-1988
Skills
- Claims support
- Claims processing
- Claims documentation
- Coverage verification
- Customer support
- Customer issue resolution
- Customer inquiry management
- Billing resolution
- Sales analysis
- Product knowledge and promotions
- Call center expertise
- Live chat support
- Google Workspace proficiency
- Strategic planning
- Problem resolution
- Decision-making
- Self-motivation
- Organizational skills
- Adaptability in dynamic environments
- Problem-solving abilities
- Guest relations
Certification
CPR Certification, Present
Additional Information
I have over 25 years of experience in call center background from inbound and outbound calls. I have worked as a Sales Associate, Member Services and also in the field of insurance first notice of loss and Adverse Claim Adjuster. I'm well trained in all areas in which you will find within my resume plus, I am a people person and try hard to get my job done right the first time. I am always open to learn new ideas on the job and I follow all rules within the workplace. I'm always willing to step in to help others when needed and I don't mind working on my days off if needed. I have moved up in many of my jobs by being open to learn and help others at the same time because I'm self-motivated and I am a team player.
Languages
English
Timeline
Claims Advocate
Included Health
08.2024 - Current
Auto Insurance Specialist
USAA Auto Claim
11.2017 - 07.2024
Customer Service Sales Representative
UnitedHealthcare
06.2014 - 09.2017
Part-Time Tax Preparer
TaxSlayer
01.2013 - 05.2018
Concierge Front Desk
Palms At Lake Spivey
09.2011 - 06.2014
High School Diploma -
Andrews High