DANIELLE FALLS

Greer, South Carolina ***** 864-***-**** ad28pn@r.postjobfree.com

WWW: www.linkedin.com/in/danielle-falls/

Professional Summary

Seasoned professional with 15 years of experience in customer service, claims processing, and benefits verification. Expert in managing high-volume claims, ensuring compliance with policies, and providing exceptional customer service. Excelled in roles requiring meticulous documentation, data accuracy, and efficient handling of sensitive information. Adept at streamlining processes with a proven track record in improving office efficiency and exceeding performance goals. Skills

Electronic Health Records

Data Entry

Salesforce

Medical Terminology

CPT Codes

Attention to Detail

Insurance Knowledge

Adaptability and Flexibility

Critical Thinking

Benefits Explanation

Decision Making

Problem-Solving

Analytical Skills

Microsoft Office

Self-motivated

Active Listening

Advanced computer skills

Claims Investigation

Effective time management and multitasking

Types 70+ WPM

Work History

Applications Specialist 07/2023 to 11/2023

Access TeleCare (Formerly SOC Telemed) – Remote, SC Ensured accurate and timely completion of onboarding, re-appointment, and implementation applications, facilitating physician signatures and document submissions to the Privileging Coordinator. Maintained strict adherence to Joint Commission credentialing standards and company policies through diligent management of application processes and documentation. Enhanced office efficiency by streamlining internal communications and correspondence, contributing to the reduction of overall workload to manageable levels. Benefits Verification Specialist 11/2020 to 05/2023 Cencora (Formerly AmerisourceBergen) – Remote, SC

Conducted thorough benefits verification, ensuring accurate documentation of patient coverage, cost-sharing details, and provider networks for various insurance plans. Managed prior authorization and claims appeal processes, maintaining compliance with HIPAA and confidentiality standards.

Applied expertise in CPT codes, diagnosis codes, and medical terminology to support healthcare administrative functions.

Exceeded performance targets by completing over four comprehensive benefit verifications daily, demonstrating proficiency in utilizing platforms like Salesforce, Transunion, and CenterX. Claims Specialist 11/2019 to 09/2020

98 Ventures – Greenville, SC

Managed daily claim processing, accurately recording all activities in the database and efficiently handling an average of 20-30 claims per day, ensuring prompt and precise response to claimant inquiries. Conducted thorough quality assurance reviews on outgoing payments and prepared comprehensive summaries of claim investigations for executive review, contributing to the integrity and reliability of the claims resolution process.

Analyzed claims data to streamline resolution in alignment with company policies, provided exemplary customer service in dispute resolution and process clarification, and facilitated cross-departmental collaboration for continuous improvement of operational procedures. Debt Specialist I 12/2018 to 11/2019

TD Bank – Greenville, SC

Handled escalated customer inquiries, addressed delinquent account concerns, and maintained precise account records.

Fostered positive customer relationships through exceptional service, resolving disputes with prompt and effective problem-solving.

Facilitated customer payment solutions tailored to individual financial situations and conducted thorough investigations into billing complaints.

Senior Teller 05/2018 to 11/2018

Synovus – Columbus, GA

Managed and processed diverse financial transactions, including loan and credit card payments, ensuring accuracy and adherence to anti-money laundering regulations. Strengthened customer loyalty by delivering outstanding service and promptly addressed inquiries, fostering strong client relationships.

Exceeded sales targets through effective cross-selling of bank products, while meticulously verifying customer account information to maintain transactional integrity. Receptionist 08/2017 to 03/2018

ProSource Plumbing Supply – Greenville, SC

Managed front desk operations, promptly greeting visitors and efficiently directing them to appropriate departments, while maintaining a neat and well-supplied reception area. Developed and maintained professional documents using Microsoft Office Suite and coordinated scheduling for conference rooms to support internal and external meeting requirements. Branch Support Specialist 07/2016 to 08/2017

World Acceptance Corporation – Greenville, SC

Delivered high-level customer service and technical support, resolving customer issues promptly and maintaining accurate help desk documentation.

Conducted effective training for users on organizational systems, enhancing their proficiency in various applications.

Improved operational procedures by identifying areas for enhancement and implementing tailored solutions to meet customer needs, while ensuring strict adherence to security protocols. Rapid Response Associate/Claims Adjuster 04/2015 to 07/2016 Esurance – Greenville, SC

Analyzed and processed insurance claims, determining coverage and assessing liability and damages in accordance with policy terms and state regulations. Conducted thorough investigations, including document reviews and claimant interviews, to compile evidence and support accurate claim evaluations.

Maintained high standards of customer service, efficiently managing a large volume of inbound calls and resolving complaints with professionalism and promptness. Debt Specialist II 07/2014 to 04/2015

TD Bank – Greenville, SC

Evaluated customers' financial statuses to devise optimal recovery strategies for outstanding debts. Negotiated repayment terms with clients, fostering the settlement of overdue accounts. Documented collection efforts and payment agreements, adhering to legal and ethical guidelines. Banking Specialist I 02/2013 to 07/2014

TD Bank – Greenville, SC

Enhanced customer satisfaction by resolving account issues and educating clients on online and mobile banking applications, ensuring a proficient and secure banking experience. Contributed to business growth through effective cross-selling of products and services, while maintaining vigilance in monitoring suspicious account activities to safeguard client interests. Teller 06/2011 to 02/2013

Wells Fargo – Anderson, SC

Managed daily cash transactions, ensuring the accuracy of cash drawer balances and resolving discrepancies to maintain integrity in financial reporting. Delivered high-quality customer service by addressing inquiries and educating customers on utilizing digital banking tools, thereby enhancing customer engagement and satisfaction. Identified and leveraged cross-selling opportunities to recommend banking products aligned with customer needs, fostering trust and contributing to customer retention. POS Associate 08/2008 to 09/2011

Kohl's – Anderson, SC

Provided customer service, addressing inquiries and resolving concerns, while promoting store loyalty and repeat business through informed and friendly interactions. Managed financial transactions with precision, including accurate cash drawer reconciliation and counterfeit detection, ensuring fiscal responsibility. Trained new associates in the operation of sales software systems and effectively cross-trained in multiple roles to support team needs during peak periods. Accomplishments

Kohl's Top Performer for two years straight

Trained and mentored numerous new hires.

Earned Stellar Teller Award for top performance.

Promoted to Debt Specialist II after only one year for exceptional performance. Processed an average of 8-10 claims per day, exceeding company targets. Consistently exceeded daily benefit verification goals. Education

High School Diploma 05/2007

Pendleton High School - Anderson, South Carolina

Awarded Principal's Award for class of 2007

References

Ethel Estrella (former co-worker) - Cencora

Phone Number: 484-***-****

E-mail: ad28pn@r.postjobfree.com

Chris Caldwell (former manager) - 98 Ventures

Phone Number: 828-***-****

E-mail: ad28pn@r.postjobfree.com

Talycia Bilbo (former manager) - Access TeleCare

Phone Number: 682-***-****

E-mail: ad28pn@r.postjobfree.com

Languages

English

Native or Bilingual

Spanish

Professional Working

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