Administrative Assistant Customer Service

CRYSTAL R. HARRIS

Experienced Claims Adjuster

Texas All-Lines Adjuster Texas Department of Insurance

Irving, Texas

C: 817-***-**** **********@*****.***

PROFESSIONAL SUMMARY

Eagerly ready to enhance your company as a versatile and hardworking Claims Representative, driven to improve productivity and customer relations with attention to detail, professional demeanor, time management skills and a keen understanding of the insurance industry.

SKILLS Multi – Tasking Skills, Excellent communication Skills(Written and Spoken), Professional phone etiquette, 15 years Customer Service, 10 years Problem solving(putting together a puzzle), HIPAA compliance, Medical Terminology, Compensation and benefits, Knowledge of CPT, ICD-9 and 10 codes

WORK HISTORY

UNITED HEALTHCARE

Claims Processor Richardson, TX February 2016 – Current

•Responsible for examining UB and CMS 1500/HCFA rework claims for complex and simple processing errors for Government employees, Medicare, Medicaid, Tertiary policy holders

•Examining claims for any processing errors made by First Pass processors or errors made while in auto-adjudication process.

•Multi-tasking between several systems to research and confirm pay out for claim which includes DUMY-ing into the claim before processing to insure correct pay out.

•Research in UNET system includes checking member benefits comparing to provider fee schedule

AETNA

Health Concierge Arlington, TX June 2014 - November 2016

•Handled incoming calls for TRS and Federal employee benefits including health, life, dental, vision, flex spending accounts, retired benefits

•Sent member eligibility requirement correspondences for open enrollment, coordinated benefits with other insurances as well as Medicare

•Resolved claim discrepancies including coding, benefit accumulation issues and simple processes of member claims.

•Maintained confidentiality with members accounts information in respects to HIPPA guidelines, educated members on policy details.

IN MILORD'S HANDS

Administrative Assistant Dallas, TX September 2011 - June 2014

•Managed incoming and outgoing patient claim correspondences

•Maintained accounts payable for each in house client

•Analyzed health benefits and eligibility, performed administrative and clerical work

•Scheduled patient medical visits.

EDUCATION

•TEXAS ALL-LINES ADJUSTER Insurance Claims Adjuster Texas Department of Insurance – Certified Claims Adjuster

•Tarrant County College

Arlington, Texas

•Concorde Career Institute

Grand Prairie, Texas

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