Support Specialist Insurance
Resume:
Cionne' D. Smith
********@******.*** Houston, Texas 77003
CAREER OBJECTIVE: Meticulous Insurance Specialist with excellent planning and problem solving abilities. Offering 15 years of experience and a willingness to take on any challenge. Organized, driven and adaptable professional with successful history managing high caseloads in fast-paced call center, hospital, office setting and remote environments. EXPERIENCE
PATIENT SUPPORT SPECIALIST (WFH), Torrance, California Optum/United Healthcare,
- Applies knowledge/skills to activities that often vary from day to day.
- Demonstrates a moderate level of knowledge and skills in own function.
- Requires little assistance with standard and non-standard requests.
- Solves routine problems independently.
- Works with supervisor to solve more complex problems.
- Prioritize and organized personal assignments to meet scheduled deadlines.
- Worked efficienty with a team to accomplish the tasks set. September 2022-Present
INSURANCE SPECIALIST (WFH), New Orleans, Louisiana Humana,
- Assist providers with claims and policy information while maneuvering through multiple systems at once·
- Responsible for knowledge and informative managed denials, late payments, extensions and other special circumstances by following up with relevant parties.
- Diligently filed and followed up on third party claims.
- Resolved routine and complex issues by performing detailed research.
- Closed sales on new policies by presenting insurance options to customers accurately and efficiently. October 2019-July 2021
HEALTHCARE ADVISOR/BUSINESS ANALYST (WFH), Tucson, Arizona Broad-Path Healthcare Solutions,
- As a medical consultant I am responsible for providing inbound customer service to various providers.
- Analyzes and verifiy inquiries using on-line systems, use of hard copy data when necessary, and related research material.
- Process correspondence and payments for members. - Provide assistance to members in getting proper medical services within the scope of their policy.
- Confirm and verify patient coverage, benefit type and eligibility/effective dates.
- Review and provide estimate of patient's out of pocket expenses for select procedures and services.
- Search members benefit information such as deductible, co-payments,coinsurance percentages and find matching INN/OON, par providers who are available to provide services.
- Advised Medicare members on available supplemental benefit.
- Initiate claims adjustments and update enrollment information through on-line systems as determined. December 2014-January 2018
INSURANCE SPECIALIST (WFH), Chicago, Illinois
Jacobson Healthcare Solutions,
- Educated Peoples Health members regarding health benefit.
- Liaison between members, pharmacies and medical management to ensure payment and authorization.
- Conducted claims research for payment or denial of services.
- Provided member eligibility and benefit verification to authorized provide. September 2012-May 2013
PROVIDER SERVICE ADVISOR 1/PROVIDER ENROLLMENT, Baton Rouge, Louisiana Blue Cross Blue Sheild,
- Researched provider dispute resolutions.
- Verify benefit and eligibility for Blue Cross Blue Shield members for providers.
- Conducted claims research calls to determine if claim payment should be processed.
- Provided written and verbal correspondence to medical management and members for services.
- Recovered monies for Well Point through medical billing collection efforts.
- Internet based Provider Enrollment chain and ownership system (Pecos) to enroll or make a change in your Medicare enrollment if available for your provider.
July 2009-June 2012
EDUCATION
HIGH SCHOOL DIPLOMA, New Orleans, Louisiana
John F Kennedy High, May 1997
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