Kimberly T. Valdery
Atlanta
Summary
To obtain a position within a major corporation that advocates job security and room for advancement in a career setting environment. Allowing the employee to work independently utilizing initiative and acquired skills.
Overview
23
23
years of professional experience
Work History
Premier Member Advocate
United Healthcare Group
06.2023 - Current
- Handled complex claim issues, effectively communicating with patients, providers, and insurance companies to ensure resolution.
- Maintained member records and updated electronic health systems to safeguard data.
- Researched and applied relevant healthcare laws and regulations to support compliance..
- Educated members on healthcare options, benefits, eligibility and financial support resources.
- Monitored and updated claims status in claims processing system.
- Verified patient insurance coverage and benefits for medical claims.
- Maintained knowledge of benefits claim processing, claims principles, medical terminology, and procedures and HIPAA regulations.
- Evaluated medical claims for accuracy and completeness and researched missing data.
- Researched and resolved complex medical claims issues to support timely processing.
- Effectively resolved claim disputes by conducting thorough investigations and presenting findings to stakeholders clearly and concisely.
- Maintained confidential patient, employee and company information in compliance with company policies and regulatory requirements.
Executive Assistant
Casting Bait Music Group
09.2015 - Current
- Prepare music for release on label by sending it to mastering and all major streaming platforms
- Prepare and publish press releases
- Call and email playlist curators
- Call and email radio stations, social media influencers and online blogs for marketing of new and existing projects
- Manage all marketing and promotion for each record release
- Update/submit online content and monitor for accuracy
- Generate / prepare reports from all streaming sites for RIAA certification
- Apply for RIAA certifications
- Register artist works with BMI and ASCAP for publishing rights
- File for copyrights and trademarks for artist works
- Strong communication with attorney for legal assistance
- Prepare contracts for side artists and exclusive rights production purchases
- Manage calendars and appointments with an understanding of business priorities
- Draft and edit correspondence, communications, presentations and other documents
- Anticipate and coordinate the labels point-to-point travel needs (accommodations and car service)
- Conduct research on request and maintain a general awareness of industry trends, entertainment news and social media, talent and competitive environment
Reservations Specialist
SouthWest Airlines
10.2016 - 05.2017
- Utilized computerized reservations system including a video display terminal and keyboard on a constant basis to book reservations and retrieve information on flights and schedules
- Works in a highly organized, restrictive environment requiring extended periods of time at a fixed work position answering telephone calls within established guidelines, procedures, and performance standards
- Resolved general Customer Service concerns through effective Customer Service techniques
- Answered Customer inquiries regarding flight arrivals, delays, cancellations, flight irregularities, facilities, and other general information.
- Finalized sales of Southwest Airlines flights, sells ancillary products, confirms reservations, and provides information regarding ticket purchase and other special services
- Communicated with Customers by telephone, or through electronic channels, to furnish information regarding fares, schedules, routings, flights and availability of space for travel on Southwest Airlines
Operations & Service Support
Norfolk Southern Rail
06.2010 - 09.2015
- Always making safety a first priority
- Accurately and timely reporting of train and rail car activity
- Verifying inbound and outbound interchanges of foreign lines
- Protecting charges for revenue switches, miscellaneous billing and demurrage/storage charges setbacks, etc
- Detailed documenting of derailed cars/trains
- Obtaining clearance files for high & wide loads, overloads, embargos and haulage moves
- Adhering to FRA regulations regarding Hazmat and RSSM COC guidelines
- Sending 417/418 to foreign lines for billing and car movement purposes and creating EDI’s to assist in expediting car movement as well as transfer of liability
- Building, editing and executing industry work orders
- Assisting conductor’s, trainmasters and engineers with accurately reporting industry/joint industry work via the remote intelligent terminals (RIT)
- Engine reporting via crew call system
- Working closely with customers in preventing shutdown occurrences and receiving their shipments in a timely manner
- Documenting rejected load reasons
- Adding and removing stop-offs for mechanical repair locations for bad orders
- Processing customer requests via phone, fax and email regarding releases of cars, car ordering, switch request, disputes lease tracks and LOPA failures
- Validated and reassigned class-codes for proper routing
- Assessed and documented trends to allow for correction of business processes or product issues from consumer feedback and internally that may require immediate attention
Corporate Consumer Advocate / Executive Relations
Motorola
10.2005 - 04.2009
- Provided global/international support and management for all mobile device call centers
- Completed weekly product safety test calls to the call centers for evaluation of quality, performance and compliance
- Received corporate and consumer escalations on a daily basis via telephone, email, fax, mail correspondence, etc
- From consumers whom wish to escalate to the corporate level
- Created/composed hundreds of custom letter templates in response to consumer concerns
- Respondent to Better Business Bureau and Attorney General cases, addressing consumer issues and resolving their complaints in a timely manner
- Supported mobile device products and services including product safety and compliance inquiries relating to; product accessibility, electromagnetic energy and environmentally safe products
- Evaluated the validity with respect to consumer claims of product safety issues regarding personal injury and property damage – Acquired all pertinent information needed to process the consumer claim in coordination with the engineering, legal and insurance departments
- Represented a single point of contact for all escalated issues including to that of the senior executive up to the CEO’s office – advocating a reasonable solution for the company and consumer
- Developed a new cataloging and tracking process along with excel worksheets for dealer warranty support also in efforts to deter fraud activity
- Order approval, order entry, managing back-orders, credits, charge back, fraud inquiries and shipping deadlines
- Worked directly with credit card companies and financial institutions in resolving disputes and address verification
Senior CSR / Tier I Tech Support
Verizon Wireless
06.2001 - 06.2005
- Assisted over 150 customer’s daily with billing inquiries, payments, plan changes, etc
- Reduced the churn rate by 5-15 customer’s daily
- Assisted customer’s with manual equipment programming, data issues (i.e
- Wireless internet, wireless sync, blackberry support, switch delays, porting telephone numbers to different carriers and basic network issues)
- Relocated 50-75 customer’s per day to anywhere in the world Verizon service was offered
- Utilized a combination of 30 different programs, systems and reference materials to make the transition as seamless as possible
- Ran credit and provided additional assistance to direct/indirect agents regarding consumer and business credit inquiries
- Verified consumer eligibility for service via the Social Security Administration, Trans Union, Experian and Equifax credit reporting agencies – Business customers were verified via Dunn & Bradstreet, Experian and the Secretary of State
- Activated new consumer and business accounts as well as point of sale failed activations
Education
Diploma -
Jones Commercial H.S
Chicago, ILUndergraduate -
Harold Washington College
Chicago, ILSkills
- Skills / Acquired Knowledge:
Occupational safety training, hazmat training, very comprehensive, skilled problem solver, strong verbal and written communication skills, strong analytical skills, strong leadership abilities, working independently, negotiation and closing skills, client relationship building and maintaining, typing (55 wpm), 10 keystroke, Microsoft Office and numerous other systems and reference materials
Medical / Pharmacy Coding and Terminology Knowledge
Patient Confidentiality Procedures (HIPAA)
Detect, analyze, investigate and process medical claims
Medical Insurance Policy Coverage / Eligibility Knowledge
Investigate and report medical claims for waste, fraud, abuse and errors
Reprocess Medical Claims
Pharmacy Formulary knowledge
Claim Payment adjustments and resolution
Knowledge of Medical Codes:
- CPT
- HCPCS
- ICD10
- ICD9
- Modifiers
- Revenue
Prior Authorization Procedures (ICUE)
Medical Claims Forms
- 1500
- UB04
Claims Appeal / Terms
EOB Knowledge
CRM Tools
AS400
SAP
Additional Information
- Accomplishments: , Senior Universal Rep, Perfect Calls, Certificates of Achievement, MVP Awards, Certificates of Completion, Inter-Office promotions, Perfect Attendance and Employee of the Month Awards, White Belt Certification.
Timeline
Premier Member Advocate
United Healthcare Group
06.2023 - Current
Reservations Specialist
SouthWest Airlines
10.2016 - 05.2017
Executive Assistant
Casting Bait Music Group
09.2015 - Current
Operations & Service Support
Norfolk Southern Rail
06.2010 - 09.2015
Corporate Consumer Advocate / Executive Relations
Motorola
10.2005 - 04.2009
Senior CSR / Tier I Tech Support
Verizon Wireless
06.2001 - 06.2005
Diploma -
Jones Commercial H.S
Undergraduate -
Harold Washington College
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