Seasoned claims benefit specialist with excellent planning and problem solving abilities. Offering several years of experience and a willingness to take on any challenge. Organized, driven and adaptable professional with successful history managing high caseloads in fast-paced environments.
Overview
20
20
years of professional experience
2
2
years of post-secondary education
Work History
Claims Benefit Specialist
Aetna, a CVS Health Company
Hampton
01.2022 - 04.2026
Reviews and adjudicates routine claims in accordance with claim processing guidelines.
Reviewed and verified claims or referral submissions to ensure compliance with guidelines, coding, member identification, diagnosis, and pre-coding requirements.
Analyzed claims for accuracy and compliance with company policies.
Updated knowledge of relevant laws, regulations, policies, and procedures related to benefit programs to ensure accurate claims processing.
Trained new team members on claims processing procedures to enhance team knowledge and efficiency.
Customer Care Specialist
WPS Health Solutions
Hampton
07.2017 - 01.2018
Resolved customer complaints through effective communication and problem-solving techniques, enhancing customer satisfaction and loyalty.
Assisted customers with inquiries about health plans and coverage options, ensuring clarity and understanding of available benefits.
Educated clients on benefits and services offered by WPS Health Solutions.
Establish and build rapport with beneficiaries and providers to provide a corporate image while responding in a timely manner
Monitored incoming calls and ensured timely responses to customer needs.
Processed claims and maintained accurate records in customer management systems, contributing to streamlined operations and reduced errors.
CUSTOMER SERVICE REPRESENTATIVE
TRG Customer Solutions
Hampton
08.2006 - 04.2012
Handled escalated calls, ensuring satisfactory resolutions and customer retention.
Provided excellent customer service to resolve customer complaints in a timely manner.
Assisted customers with inquiries and resolved issues promptly.
Educated customers on products and services while resolving billing inquiries.
Developed strong customer relationships to encourage repeat business.
Managed customer accounts and updated information accurately.
Maintained positive attitude while managing high call volumes to enhance customer experience.
Education
Bachelor of Science - Health Care Administration
University of Phoenix
Tempe, AZ
08.2024 - 05.2026
High School Diploma -
Phoebus High School
Hampton, VA
Skills
Insurance Claims Processing
Claims processing
Regulatory Compliance
Customer Service
Customer Care
Call Center
Data Analysis
Data Entry
Excel
Microsoft Word
Computer Literacy
Office Experience
Time Management
Personal Information
Work Permit: Authorized to work in the US for any employer