Life Insurance Client Relations

LATRICE D. KERR

PHONE: 254-***-****

EMAIL: ad5cxo@r.postjobfree.com

ad5cxo@r.postjobfree.com

LOCATION: Dallas/Fort Worth

CAREER PROFILE:

Professional Summary

Senior performance-driven claims professional with 20 years of diverse knowledge and skills.

Ability to problem solve and analyze complex situations. Detailed-oriented and strategic thinker.

Have a keen focus on claims processing and client relations. Possess a professional demeanor

demonstrated by integrity and results.

Core Competencies

Client Relation and Engagement Microsoft Office Suite Strong Communication Attention to Detail

Documentation Management Problem Solving Time Management Claims Handling and Investigation HIPAA

EOB knowledge ICD and CPT codes

Education

Associate of Science- Medical Administration Management

Colorado Technical University

Graduated February 2013

EXPERIENCE:

Independent Business Owner, Garland, TX 5/2019 – 11/2023

• Contact leads to secure their business for Life insurance, Annuities, IUL’s, Preneed services, and

Medicare.

• Verify client’s providers are in network with the Medicare plans that assign them as well as provide

them with adequate resources for the first appointment.

• Perform notary services including reception of closing documents, verification of all pertinent

information, scheduling appointments with clients and notification of lender.

• Execute meeting with homeowner and witness signatures on closing documents, notarize documents

and ensure expedited return to lender.

Centene, Austin, TX 5/2016 – 3/2017

Referral Specialist II

• Review accuracy and completeness of treatment requests from providers for patients DME and

nurses.

• Create member authorizations for approved visits for nurses and DME.

• Verify member eligibility and provider contracting/credentialing status prior to authorization.

• Coordinate treatment request with Care Coordinators for Out of Network DME providers.

• Modify authorizations as needed to ensure transfer into claims system.

• Track and maintain monthly reporting log

• Managed incorrectly paid claim request, researched the claims for accuracy and reprocessed any corrected claims.

• Issued check tracers for payments not received. As well as issued refund requests.

American Specialty Health, Southlake, TX 5/2013 – 1/2014

Claims Analyst

• Responsible for correctly identifying claims that were processed incorrectly

• Adjusting Acupuncture, Chiropractic, Physical Therapy, and Massage Therapy claims

• Correcting system issues

• Distribution of claims that are handled in a diverse range of areas and coordination of benefits

• Responding to claims questions via email as well as managed all overpayments

Fidelity National Agency Solutions, Plano, TX 8/2012 – 2/2013

Policy Processor

• Responsible for efficiently navigating title policy processing systems

• Tracking title policies that require additional information to complete

• Entering information into the policy processing system once received to complete issuing of policy

First Care Health Plans, Austin, TX 6/2011 – 11/2011

Adjustment Specialist

• Provide quality service to providers through real time and accurate resolution of adjustments

• Respond to routine provider inquiries regarding claim and adjustment status escalations

• Review, analyze and disposition medical and facility claim adjustments

• Proactively identify and provide resolution to provider issues to minimize future calls

• Maintain proficiency in all technical applications and systems

• Work refund and overpayment requests

Texas Association of School Boards, Austin, TX 11/2008 – 11/2010

Benefit Administrator II

• Served as liaison between vendors and employees for all benefit matters

• Compiled and maintained benefit records and documents in accordance with federal guidelines

• Processed Worker’s Comp claims in accordance with federal and state guidelines

• Reviewed, evaluated, and investigated medical bills for compensability of medical services in

compliance with the Texas Workers’ Compensation Act.

• Researched appeals and partnered with providers on resolutions

• Managed refund request process and partnered with third party vendors for resolutions

• Assisted with providing training on new material, plans, and information to administrative staff

Boon-Chapman, Austin, TX 5/2002 – 6/2008

Claims Analyst/Supervisor

• Supervised a team of 8 employees and analyzed medical and dental claims

• Determined eligibility of submitted claims and made decision on appropriate action (pay, deny, or

request additional information)

• Determined payment based on contract and fee schedule

• Investigated all excess and questionable charges for refund or overpayment resolutions

• Adjusted various types of claims that required correction based on contract or fee schedule to

provide provider with correct payment or EOB

• Processed Medicaid, Medicare, and Specialty Program claims and determined possibility of

Coordination of Benefits (COB) on each claim

• Investigated COB information and calculated benefits accordingly

• Communicated payment of benefits with claimants, health providers and other interested parties

• Provided direct reports with on-going training and development

• Resolved all escalated calls/ issues and concerns from clients

Contact this candidate