MAKAELA CUMMINGS

Lake Charles, LA *****

337-***-****

ad151z@r.postjobfree.com

Detail-oriented and meticulous professional with over 2 years of experience in data entry, customer service, and healthcare. Adept at employing efficiency-enhancing technologies and tools such as Microsoft Excel, Google Sheets, and various CRM platforms to ensure the accuracy and timeliness of data input and management. Eager to contribute to the company's success through hard work, attention to detail, and excellent organizational skills. Familiarity with insurance regulations and industry standards

Excellent analytical and problem-solving skills

Exceptional attention to detail and accuracy

Effective written and verbal communication abilities Ability to prioritize tasks and meet deadlines in a remote work environment

Inbound and outbound calling

Quality control

Group Health Insurance Administration

Carrier Enrollment and Data Reconciliation

Customer Service Excellence

COBRA and PHI Compliance

Task-Oriented with Strong Organizational Skills

Ability to Multitask and Prioritize Workload

Proficient in entering and updating data in a variety of software systems, ensuring accuracy and completeness of information

Skilled in Microsoft Excel, Google Sheets, CRM platforms, and other database management systems

Team Collaboration Collaborative team member,

experienced in working in a fast-paced, dynamic

environment

Communication (Written, Verbal, Listening)

Call Center Operations

Data Entry

Problem Solving

Conflict Resolution

Medical and Claim Terminology

HIPAA Compliance

07/2023 to Current

CONDUENT

Quality Assurance Auditor

Conducts internal audits to ensure compliance with quality standards. Performs detailed analysis of data elements in patient health information systems to detect discrepancies. Creates reports documenting findings from audits and analyses of electronic medical records data. Analyzes electronic medical records for accuracy and compliance with applicable standards and regulations. 05/2017 to Current

SERVICE CARE LLC

Appeals and Grievances Coordinator

Analyzed and resolved verbal and written claims, medical pre-service appeals, Part D pre-service appeals from both providers and members.

Analyzed and resolve verbal and written grievances and CTMs from members and legal representatives. Took verbal grievance and appeals requests from Member Services and/or other departments and migrate to the organization's Appeals &

Grievance system for tracking and processing.

Conduct outreach to members and providers for additional information required to resolve grievance and appeals cases. This may involve

placing outbound calls or sending faxes or e-mails. Analyzed complex cases to determine appropriate resolution in accordance with relevant laws, regulations and organizational policies.

08/2020 to 07/2023

SOUTHWEST INDEPENDENCE CENTER

Claims Specialist

Processed an average of 40 claims per day, ensuring accuracy and adherence to company guidelines and industry regulations. Utilized claims management software to track and monitor claims status, communicate with stakeholders, and generate reports for management analysis.

Demonstrated exceptional customer service skills by addressing claim-related inquiries and concerns, resulting in a 90% increase in customer satisfaction ratings.

Received commendations from team members and supervisors for consistently meeting or exceeding productivity and quality targets.

HIGH SCHOOL DIPLOMA

Welsh High School, Welsh, LA

MEDICAL ASSISTANT

Unitech Training Academy - Lafayette, Lafayette, LA SUMMARY

SKILLS

EXPERIENCE

EDUCATION AND TRAINING

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