Victoria Daniels
Alvin ,TX
Summary
Diligent Claims Processor versed in insurance processes and claims procedures. Offers great attention to detail and time management abilities to successfully handle large volume of claims. Highly accurate and thorough with focus on completing error-free work in line with processing guidelines.
Overview
5
5
years of professional experience
Work History
Claims Processing Specialist
Aetna, A CVS Health
07.2022 - Current
- Utilized specialized software to process incoming claims, enter data and generate reports.
- Managed workload and priorities to meet claims processing meet deadlines.
- Reviewed applications and supporting documents to verify claims eligibility and accuracy.
- Responded to customer inquiries, providing detailed explanations of insurance policies and claims processes.
- Utilized excellent analytical and problem-solving skills to quickly and accurately assess insurance claims.
- Developed and implemented quality assurance processes to check accuracy of claims processing.
Office Administrator
Orkin Pest Control
09.2021 - 07.2022
- Interacted with customers by phone, email, or in-person to provide information.
- Maintained electronic and paper filing systems for easy retrieval of information.
- Reconciled account files and produced monthly reports.
- Facilitated office productivity, coordinating personnel schedules, quality assurance and procedural improvements.
- Maintained positive customer relations by addressing problems head-on and implementing successful corrective actions.
- Maintained professional demeanor by staying calm when addressing unhappy or angry customers.
Customer Service Representative
Remedy Staffing Agency
04.2019 - 07.2021
- Answered constant flow of customer calls with minimal wait times.
- Actively listened to customers, handled concerns quickly and escalated major issues to supervisor.
- Maintained customer satisfaction with forward-thinking strategies focused on addressing customer needs and resolving concerns.
- Participated in team meetings and training sessions to stay informed about product updates and changes.
- Met customer call guidelines for service levels, handle time and productivity.
- Followed up with customers about resolved issues to maintain high standards of customer service.
Education
General Studies
Columbus State Community College
Columbus, OHGED -
Ohio Department of Education
Columbus, OH2012
Certification - Medical Billing & Coding
Franklinton Career Center
Columbus, OH06.2005
Skills
- Claims Review
- Transactions Reconciliation
- Claims
- Regulatory Compliance
- Claim Amount Calculations
- Insurance Claim Forms Review
- Customer Service
- Data Entry
- Medicaid Knowledge
- Prior Authorization Processing
- Claims Adjustment
- Coverage Determination
Timeline
Claims Processing Specialist
Aetna, A CVS Health
07.2022 - Current
Office Administrator
Orkin Pest Control
09.2021 - 07.2022
Customer Service Representative
Remedy Staffing Agency
04.2019 - 07.2021
General Studies
Columbus State Community College
GED -
Ohio Department of Education
Certification - Medical Billing & Coding
Franklinton Career Center
Similar Profiles
CHRISTINE DOLSCHRISTINE DOLS
SENIOR MANAGER, NETWORK CONTRACTING at Aetna, a CVS Health Company (First Health Network)SENIOR MANAGER, NETWORK CONTRACTING at Aetna, a CVS Health Company (First Health Network)
SYDNEY ZEUCHSYDNEY ZEUCH
Care Management Coordinator at Aetna, a CVS HealthCare Management Coordinator at Aetna, a CVS Health
Emilee EichelbergerEmilee Eichelberger
Plan Coordination Consultant at Aetna, a CVS HealthPlan Coordination Consultant at Aetna, a CVS Health
JENNIFER PATTERSONJENNIFER PATTERSON
Supervisor, Plan Sponsor Services at Aetna, a CVS Health CompanySupervisor, Plan Sponsor Services at Aetna, a CVS Health Company
Ashley StewartAshley Stewart
Regional Administrator at SuperheatRegional Administrator at Superheat