T'KEYAH MOORE
Included Health
Remote
8
years of professional experience
Professional with strong background in claims management, equipped with critical skills in conflict resolution, policy interpretation, and customer service. Adept at collaborating with team members to ensure seamless operations and achieving results. Reliable and adaptable, capable of meeting evolving organizational needs with focus on delivering high-quality outcomes.
Work History
Claims Representative
11 Months- Resolved complex claims inquiries by analyzing client information and policy details.
- Coordinated with healthcare providers to ensure accurate processing of claims submissions.
- Implemented process improvements, increasing efficiency in claims resolution workflows.
- Trained new representatives on claims handling procedures and company policies.
Claims Service Representative
1 Year 2 Months- Enhance customer satisfaction by efficiently processing and resolving claims in a timely manner.
- Enhanced customer satisfaction through timely processing and resolution of claims.
- Utilized analytical skills to identify trends in claim data, improving decision-making processes.
- Conducted thorough investigations into complex claims, ensuring fairness for all parties.
Medical Claims Specialist
2 Years 2 Months- Processed medical claims, ensuring compliance with regulatory guidelines and payer requirements to facilitate timely reimbursements.
- Conducted audits of processed claims to verify adherence to company policies and industry standards, enhancing claim accuracy.
- Reduced errors in claims submissions through meticulous attention to detail and thorough review processes.
- Streamlined workflows and implemented best practices to enhance claim processing efficiency and reduce turnaround time.
Medical Claims Representative
2 Years 3 Months- Processed and adjudicated medical claims with precision, ensuring compliance with industry regulations.
- Reviewed claim submissions for accuracy, identified discrepancies, and initiated resolutions to ensure timely processing.
- Collaborated with healthcare providers to gather documentation, facilitating efficient claim approvals.
- Analyzed trends in claim denials to recommend targeted improvements in submission practices, enhancing overall claim acceptance.
Education
Diploma
Skills
Claims management
Insurance claims review
Claim investigation
Insurance verification
Policy interpretation
Claims auditing
HIPAA compliance
Payment negotiation
Microsoft Office
Strong negotiation
Exceptional communication
Timeline
Claims Representative
Included Health
09.2025 - CurrentRead More
Claims Service Representative
Express Scripts
07.2024 - 09.2025Read More
Medical Claims Specialist
Optum
11.2021 - 01.2024Read More
Medical Claims Representative
Omada Health
12.2018 - 03.2021Read More
Georgia Cyber Academy
Diploma
Read More