Summary
Overview
Work History
Skills
Timeline
Generic

Dawn Riddick

Portsmouth

Summary

Dynamic professional with extensive experience at Anthem, Inc. specializing in claims processing and customer service. Proficient in FACETS and WGS systems, leveraging strong data management skills to enhance operational efficiency. Recognized for exceptional problem-solving abilities, consistently delivering results while ensuring client satisfaction and compliance with industry standards.

Overview

27
27
years of professional experience

Work History

Medical Office Secretary

Gastroenterology Associates Of Tidewater (OneGI)
Chesapeake
07.2024 - Current
  • Greeted patients and visitors, assessing needs and directing appropriately.
  • Answered incoming phone calls to assist with inquiries.
  • Verified and entered patient demographic information into EMR.
  • Checked for necessary referrals and ensured timely processing.
  • Collected co-pays, deductibles, and outstanding balances during visits.
  • Scheduled patient office visits, procedures, x-rays, and tests as requested.
  • Confirmed next-day appointments and procedures for patient compliance.
  • Maintained accurate patient records and coordinated specialized care.

Claims Processor II

Anthem, Inc.
Virginia Beach
11.2021 - 07.2024
  • Processed complex claims across various markets to ensure accurate adjudication.
  • Reviewed and adjusted claims for payment or denial based on established criteria.
  • Utilized Macess computer system for efficient claims processing and tracking.
  • Handled corrected claims submissions from providers following error identification.
  • Ensured comprehensive information submission for payment eligibility on codes and claims forms.
  • Applied extensive knowledge of benefits contracts, pricing, policies, and government regulations.
  • Analyzed and processed claims related to events to assess company liability and entitlements.

Claims Processor I

Anthem, Inc.
Virginia Beach
11.2019 - 11.2021
  • Process claims in a database. Adjust claims that need to be paid.
  • Correcting claims that were sent in an error.
  • Verifying the data elements before processing the claim.
  • Processing codes and claims form for payment ensuring all information is supplied before eligible payments are made.
  • Good understanding of application of benefits contracts, pricing, processing, policies and procedures, government regulation, coordination of benefits & health care terminology.

Pharmacy Customer Care CCR1

Anthem
Virginia Beach
02.2017 - 11.2019
  • Entered provider faxed authorizations into database accurately.
  • Verified prescription details for correctness of patient information.
  • Sorted and labeled incoming faxes for efficient processing.
  • Input primary diagnosis codes for each patient to ensure accurate records.
  • Received inbound calls from providers to initiate Prior Authorizations.

Project Support Death Analyst

Conduent
Chesapeake
08.2015 - 01.2017
  • Typing letters and correspondence in Microsoft Word with no direction.
  • Completing mail merges between Microsoft Word, Excel, and Access without any instruction.
  • Creating and manipulating Microsoft Excel spreadsheets.
  • Creating, updating and closing cases in the case management system.
  • Copying, filing, and faxing correspondence.
  • Performing data entry.
  • Processing defined benefit payments for retirees and beneficiaries.
  • Using databases to document issues and provide status updates.
  • Identifying, researching and resolving data discrepancies.
  • Completing Death insurance claims for Cigna, Prudential, Atena, UMNI, MetLife.

Customer Care Assistant

Conduent
Chesapeake
11.2014 - 04.2015
  • Performing Data Entry.
  • Using a computer system to update the DB system with participant elections.
  • Determining Benefit Eligibility.
  • Reviewing incoming forms for completion & accuracy.
  • Using databases to document issues & provide status updates.
  • Processing & QA'ing LMCO participants Pension Cash Out payments.

Benefit Specialist

Conduent
09.2014 - 11.2014
  • Using a computerized system, responds to participants' inquiries in a call center environment.
  • Assisted participants with the selection of their Healthcare benefits for the upcoming year.
  • Provides information on Medical, dental, vision, Life Insurance, disability, flexible spending accounts & etc.
  • Resolves/Research participant's information & Log in participant's calls.
  • Process participant's Annual Enrollment Benefits.
  • Assisted participants with updating account information in the system (password changes, address changes etc.).

Customer Serv. Lead

Aerotek Panasonic North America
02.2010 - 03.2014
  • Receive incoming calls from customers concerning their Panasonic Accounts.
  • Assisting customers with any questions or concerns they have about any professional grade product within Panasonic.
  • Entering customer's information into the database, chatting with customers that had questions or concerns about the product, emailing customers information on a product.
  • Assisting customers with technical issues they are having with any professional grade product.
  • Problem solving and reassuring the customer satisfaction.
  • Making sure that all questions and concerns are answered.

Office Manager/Receptionist

Sunshine Daycare
08.2007 - 03.2009
  • Conducted interviews for potential new hires.
  • Receive information on registered kids within the daycare. Scheduled tours & made appointments for parents to come visit the daycare.
  • Submitting information into a Windows database, making spreadsheets, assisting the manager with the employee schedules, making sure all information is up to date in the computer system.
  • Filing and other clerical duties as assigned.
  • Process payroll and attendance.
  • Hold self and team accountable for meeting or exceeding expectations.
  • Develops and provides presentations for leadership. Ensures assigned work is complete.
  • Conducts meetings with operations leadership to discuss strategy, issues, and results.
  • Manages resources based on inventory needs; updates schedules.
  • Designs and manages staff scheduling systems.
  • Establishes a set of scheduling resources and monitoring systems to manage schedule administration, communication, and track performance.

Customer Service Retention

Dell Computers
05.2002 - 11.2005
  • Receive incoming calls from customers who wish to discontinue using products or services.
  • Assisting customers who may have complaints or issues with billing, as well as customers who require products or services to be changed to best fit their needs.
  • Resolves product or service problems by clarifying the customer's complaint; determining the cause of the problem; selecting and explaining the best solution to solve the problem; expediting correction or adjustment; following up to ensure resolution.
  • Uses skills to retain current customers and services by explaining features and benefits.
  • Conducts phone based surveys and follow up on direct mail pieces.
  • Uses skills to retain current customers and services by explaining features and benefits.
  • Ensure that customers are educated and knowledgeable in the services being provided.
  • Recommends potential products or services to management by collecting customer information and analyzing customer needs.

Customer Service Rep/Verifier

Innovation Services
09.1998 - 11.2001
  • Received incoming calls from customers concerning their accounts.
  • Assisted customers with opening new accounts or those were having problems with their existent accounts.
  • Making sure all information is correct and that the customer was satisfied with all services provided.
  • Assisted customers solving any problems they needed assistance with on their account.
  • Assured the customer received accurate information on or about their accounts.
  • Maintain or exceed established Corporate, business unit, and team goals.
  • Identifies trends and improvement opportunities of methods, procedures or approaches affecting delivery of service to customers or work team.
  • Use Identification and resolution of complex customer problems, issues or concerns.

Skills

  • Avaya and Verint WFM
  • Data entry and management
  • Microsoft Excel and Word
  • Customer service excellence
  • Inventory management strategies
  • Scheduling and forecasting
  • FACETS and WGS claims processing
  • Citrix and databases proficiency
  • Eclinical experience
  • 10-key data entry skills
  • SAP expertise
  • Microsoft SharePoint knowledge
  • Electronic health records (ECW)
  • Process improvement methodologies
  • Payroll administration
  • Computer networking fundamentals
  • Microsoft PowerPoint presentations
  • Microsoft Office suite proficiency
  • Microsoft Outlook communication tools
  • Dealership operations experience

Timeline

Medical Office Secretary

Gastroenterology Associates Of Tidewater (OneGI)
07.2024 - Current

Claims Processor II

Anthem, Inc.
11.2021 - 07.2024

Claims Processor I

Anthem, Inc.
11.2019 - 11.2021

Pharmacy Customer Care CCR1

Anthem
02.2017 - 11.2019

Project Support Death Analyst

Conduent
08.2015 - 01.2017

Customer Care Assistant

Conduent
11.2014 - 04.2015

Benefit Specialist

Conduent
09.2014 - 11.2014

Customer Serv. Lead

Aerotek Panasonic North America
02.2010 - 03.2014

Office Manager/Receptionist

Sunshine Daycare
08.2007 - 03.2009

Customer Service Retention

Dell Computers
05.2002 - 11.2005

Customer Service Rep/Verifier

Innovation Services
09.1998 - 11.2001

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Dawn Riddick