Customer Service/ Claims Examiner
Resume:
Raven Bell
Arlington, TX *****
*********@*****.***
My objective is to build and obtain a stable and progressive career within the company while obtaining a position that will allow me to use my strong background, interpersonal skills and customer service for achieving the company's goals in the best possible way. Authorized to work in the US for any employer
Work Experience
Claims Examiner
Angle Health TEMP-Remote
October 2023 to May 2024
• Recognized as a highly analytical claims Examiner due to demonstrated skills in the thorough analysis and adjudication of routine claims based on claim processing and medical necessity guidelines.
• Provided hands-on assistance with the claim adjudication process through verification of coverage for eligibility and discrepancies, applying all cost containment measures.
• Identified, reviewed, or applied appropriate guidelines, coding, member and provider selection processes, and claim coding (i.e., procedure, diagnosis, and pre-coding requirements) through proofing of claims or referral submission.
• Used VBA system to process claims
• COB
• Research and resolve issues in VBA
• Assisted with Migrating contracts to VBA
Claims Examiner (TEMP)
UST/ Humana TEMP-Remote
November 2022 to June 2023
• Recognized as a highly analytical claims benefits specialist due to demonstrated skills in the thorough analysis and adjudication of routine claims based on claim processing and medical necessity guidelines.
• Provided hands-on assistance with the claim adjudication process through verification of coverage for eligibility and discrepancies, applying all cost containment measures.
• Identified, reviewed, or applied appropriate guidelines, coding, member and provider selection processes, and claim coding (i.e., procedure, diagnosis, and pre-coding requirements) through proofing of claims or referral submission.
• Used javelina until conversion to HRP system in February to process claims
• Medicare claims
Express Claims specialist
Allstate Insurance-Arlington, TX
November 2021 to August 2022
• Makes and maintains a connection with the customer by understanding and meeting their needs; serves the customer with empathy; and follows up to ensure that customer needs have been met
• Candidate preferred that can support a customer base in Central Standard Time (CST) File Documentation and Reporting
• Summarizes documents and enters into claim system notes
• Documents a claim file with notes, evaluations and decision making process Coverage, Liability and Evaluation
• Determines applicable coverage limits in basic and occasionally moderately complex claims involving single or multiple claimants
• Takes recorded statements from claimants, insureds, witnesses, etc. and prepares summaries
• Conducts investigations into minor and moderate auto accidents to obtain additional claim and coverage information and determine liability
• Reviews investigation notes and determines basic and occasionally moderately complex claim value, coverage and liability
Negotiation and Settlement Guidance
• Negotiates and settles claims in accordance with business unit best practices Benefit Advocate
UnitedHealth Group-Arlington, TX
October 2020 to February 2021
• Respond to and resolve, on the first call, customer service inquires and issues by identifying the topic and type of assistance the caller needs such as benefits, eligibility and claims, financial spending accounts and correspondence
• Help guide and educate customers about the fundamentals and benefits of consumer-driven health care topics to select the best benefit plan options, maximize the value of their health plan benefits and choose a quality care provider
• Contact care providers (doctor's offices) on behalf of the customer to assist with appointment scheduling or connections with internal specialists for assistance
• Assist customers in navigating uhc.com and other UnitedHealth Group websites and encourage and reassure them to become self-sufficient
Dispatcher
Dart Transportation-Dallas, TX
November 2019 to May 2020
• Takes client calls and communicates issues with drivers, Operations Supervisor, other Dispatchers or other managers as appropriate.
• Monitors radio, telephones and on-road provision of service for quality.
• Responsible for influencing positive employee morale and quality customer service.
• Monitors and completes driver sign-in and sign-out daily.
• May assign trips to drivers to assure adequate disbursement of trips between all assigned routes.
• Monitors daily system performance.
• Participates in analysis and review of operating performance.
• Notes closed and/or late starting of routes and communicates same to Operations Supervisor, Road Supervisors or other Dispatchers and/or
Managers as appropriate.
• All other duties, as assigned.
Claims associate- TEMP
Homeowners of America (Qtemps)-Irving, TX
March 2019 to July 2019
• Investigates new claims by reviewing first reports of loss and supporting materials, determines the best first point of contact (claimants, customers, witnesses, etc.) to gather information regarding injuries or loss; refers tasks to auxiliary units as necessary and posts file accordingly.
• Establishes action plans based on case facts, best practices, protocols, jurisdictional issues and available resources.
• Manages an inventory of property/casualty and disability claims (e.g. workers' compensation, general liability, commercial automobile, property, group benefits), evaluates compensability/liability and losses, and negotiates settlements within prescribed limits.
• Establishes accurate loss cost estimates using available resources, special service instructions, and market protocols.
• Confirms or denies coverage based on facts obtained during the investigation and advises policyholders as to proper course of action.
• Makes effective use of loss management techniques (e.g. Immediate Contact Plan, L9 check, Disability Management, open end release, first call settlements) and other resources.
• Updates files and provides comprehensive reports as required. Service Advisor
MEI Service-Arlington, TX
August 2018 to February 2019
• Greet customers when they arrive at the parts and service center and direct them to an available mechanic
• Consult with mechanics about necessary repairs and possible alternatives to expensive work
• Provide customers with in-depth information about available aftermarket and OEM (original equipment manufacturer) part options
• Answer questions about service outcome (after consulting with mechanic if necessary)
• Advise customers about warranty protections and potential cost savings
• Help customers decide between trading in a car and fixing it through our shop
• Manage and oversee the service center's workflow and scheduling
• Call customers to inform them of changes in service or to let them know their vehicle is ready for pick-up Total Loss Representative/ IAA DISPATCHER
Staff Line Temp Service-Irving, TX
May 2018 to August 2018
• Effectively communicate with customers to promptly process insurance claims on behalf of clients by answering inbound telephone calls, and responding to claim related questions;
• Accurately enter customer information in various computer systems; and
• Exceed Key Performance Metrics such as Customer and Client Satisfaction, Call Handle Time, and Number of Calls
• Communication with owner, shop and adjuster to verify property location condition and confirm release
• Audatex software
Customer Account Rep II
GM Financial-Arlington, TX
June 2017 to April 2018
• Execute day-to-day collection strategies and actively contribute to center performance objectives.
• Support center and company initiatives and demonstrate an understanding of business needs.
• Ensure actions are in compliance with company policies and laws.
• Contribute to a cooperative environment, maintain an open mind and remain positive concerning change.
• Follow call flow model using standard demand on all contacts.
• Keep calls on task and ensure efficient use of call handle time.
• Negotiate to find the best outcome and utilize collection tools appropriately.
• Demonstrate effective questioning/listening skills when speaking with customers and third parties.
• Demonstrate technical proficiency.
• Leave messages appropriately with proper speed, tone and consistency.
• Document conversations/collection activity and use holds/promises effectively.
• Adhere to the attendance and break policy.
• Maximize productive time, manage work queues and ensure multiple calls are made when appropriate.
• Develop effective internal and external business relationships. Education
High school diploma
Abilene High School
August 2007 to May 2011
Skills
• Organizational skills
• Problem solving (10+ years)
• People oriented
• Excel
• Filing
• Data Entry (10+ years)
• Customer Service Skills
• Sales
• Negotiation
• Analysis Skills
• OEM
• Pricing
• Microsoft Office (10+ years)
• Microsoft Word (10+ years)
• Teamwork (10+ years)
• Time management (10+ years)
• Accounting
• Accounts receivable
• Accounting software
• Microsoft Outlook
• Accounts payable
• QuickBooks
• Microsoft Powerpoint
• Computer skills
• Administrative experience
• English
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