Vitonia Holley Jr
Tyler,TX
Summary
Organized and dependable candidate successful at managing multiple priorities with a positive attitude. Willingness to take on added responsibilities to meet team goals.
Overview
5
5
years of professional experience
1
1
Certification
Work History
Claims Examiner
Ameritas
08.2023 - Current
- Reduced claim processing time by implementing efficient workflow strategies and prioritizing tasks effectively.
- Enhanced customer satisfaction by promptly addressing inquiries and providing accurate information on claim status.
- Interpreted policy provisions, endorsements, and exclusions to accurately determine coverage for claims.
- Mitigated fraud risks by identifying suspicious patterns in claims data and escalating concerns to appropriate teams for further investigation.
- Managed caseloads effectively while maintaining high-quality work standards and meeting strict deadlines consistently.
Physician Practice Rep
Baptist Health South Florida
11.2021 - 12.2022
- Insurance verification and scheduling complex patient appointments, diagnostic treatments or surgery
- Ensures patient medical records are ready for clinic and that all pertinent billing information has been captured and accurately entered into the appropriate computer program for processing
- Communicates effectively with patients, co-workers, physicians and practice manager.
- Answered average 60 calls per day, addressing customer inquiries, solving problems and providing health information.
Advocate4Me Representative
UHC United Healthcare
03.2021 - 11.2021
- Providing a dedicated point of contact for members and their healthcare needs
- Offered friendly and efficient service to customers, handled challenging situations with ease
- Identified, analyzed and researched systemic issues and made recommendations for resolution
- Educated patients on medicine and at-home healthcare tools
- Gathered information, assessed and fulfilled callers' needs and educated on important policies and procedures
Claims Adjuster
Assurant
01.2019 - 03.2021
- Speaking with customers via phone to verify information or to answer questions or concerns regarding claims.
- Examined claims forms and other records to determine insurance coverage
- Reviewed and analyzed suspicious and potentially fraudulent insurance claims
- Reviewed police reports, medical treatment records and physical property damage to determine extent of liability
- Evaluated and investigated over 40 claims per day and decided whether insurer should pay claim.
Education
High School Diploma -
Penn Foster High School
Miami, FL07.2014
Skills
- Customer Service
- Time Management
- Insurance Verification
- Documenting and Recording Information
- Patient Confidentiality and Data Security
- Resolving Problems
- Calm and Effective Under Pressure
- Active listening
- Critical thinking
- Verbal Communication
- Investigative skills
- Computer proficiency
- Attention to detail
- Adaptability
Certification
6-20 All Lines Claims Adjuster License
Timeline
Claims Examiner
Ameritas
08.2023 - Current
Physician Practice Rep
Baptist Health South Florida
11.2021 - 12.2022
Advocate4Me Representative
UHC United Healthcare
03.2021 - 11.2021
Claims Adjuster
Assurant
01.2019 - 03.2021
High School Diploma -
Penn Foster High School
6-20 All Lines Claims Adjuster License
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