Ensured verification and completion of a minimum of 45 encounters daily and 250 weekly.
Validated insurance benefits and secured necessary authorizations for each encounter prior to, on the date of, or the following day of pharmacy or medical occurrences.
Facilitated collaboration with internal and external service providers to ensure compliance with program policies and adherence to service level agreements.
Safeguarded patient sensitive information by upholding strict confidentiality protocols.
Assisted with business office requests for follow-up verification. Supported resubmission of admission notices. Helped obtain lifetime letters and provided notifications for specific billing instructions.
Assisted in analyzing data by reviewing various factors to address moderate scope problems. Followed established procedures to determine suitable actions based on analysis.
Motivated to manage tasks from a queue effectively. Completed work following established standard operating procedures. Received feedback from management to improve performance.
Customer Service Representative
Contractor Connections
2021 - 2023
Addressed customer inquiries by employing effective communication and problem-solving techniques.
Delivered technical support for client software, ensuring seamless user experience.
Facilitated collaboration among team members to optimize processes and enhance response times for customer requests.
Facilitated training sessions for new staff on company policies and customer service protocols.
Navigated high-stress situations with composure, ensuring professionalism while resolving disputes and conflicts.
Addressed customer complaints with empathy, fostering loyalty and encouraging repeat business.
Addressed customer inquiries regarding products, services, and company information.
Benefits Verification Specialist
AmerisourceBergen with Lash Group, Charleston, SC
02.2020 - 04.2021
Executed verification and completion of over 45 encounters daily, ensuring precision in claim processing.
Validated insurance benefits and secured necessary authorizations prior to, during, or immediately following pharmacy or medical encounters.
Facilitated collaboration with internal and external partners, including providers, physicians, utilization management, business office, and insurers, to ensure compliance with program policies and SLAs.
Entered and maintained accurate patient insurance and encounter data. Assisted patients with paperwork and obtained necessary signatures. Managed follow-ups as requested by the business office.
Executed independent work within established SOPs, applying sound judgment to address moderately complex issues.
Medical Records Clerk
Centauri Health Solutions, Orlando, FL
11.2017 - 05.2018
Verified, corrected, and maintained complete and accurate medical records to support continuity of patient care.
Managed patient appointment schedules, admission and discharge date verification, and consolidation of records across multiple encounters.
Processed and fulfilled authorized medical information requests, providing timely follow-up to physicians and approved personnel.
Maintained chart files and departmental records, ensuring compliance with unit guidelines and confidentiality requirements.
Provided administrative and clerical support, including correspondence, supply management, telephone inquiries, and proficient use of medical record systems.
Insurance Compliance Specialist
Zunch North America, Maitland, FL
05.2017 - 11.2017
Develop and prepare casualty rate, rule, and form filings, managing submissions, state objections, extensions, resubmissions, and withdrawals in compliance with state-specific deadlines.
Track and follow up with State Insurance Departments to secure filing approvals within 120 days of submission; document all approval and disapproval activity.
Support implementation of approved rates, rules, and forms by updating internal systems and ensuring filings in use are accurate and current.
Monitor, interpret, and communicate regulatory changes and trends, collaborating cross-functionally to ensure compliance and alignment with product initiatives.
Contribute to product planning, audits, and staff training, including competitor research, audit coordination, and development of training materials.
Benefits Specialist
AON Hewitt Associates, Remote
08.2016 - 03.2017
Customer Service Associate
American Signature Furniture
05.2014 - 05.2016
Customer Service Representative
Convergys, Remote
03.2008 - 01.2013
Education
High School Diploma - undefined
Lowndes High School
Valdosta, GA
Skills
Problem Solving & Critical Thinking
Administrative & Clerical Operations
Regulatory Compliance & Insurance Standards
Insurance Verification & Benefits Administration
Customer Service & Customer Relationship Management (CRM)
Call Handling & Queue-Based Workflows
Data Entry, Data Accuracy & Records Management
Pricing & Inventory Coordination
Microsoft Office Suite
Healthcare & Enterprise Systems (Lotus Notes, Rio, CSPro)