USAA Classification: Internal

Kimberly Hamilton

New Port Richey, FL

adwz1o@r.postjobfree.com

727-***-****

Authorized to work in the US for any employer

Work Experience:

Fraud Detection Specialist USAA FSB Bank

June 2021- Current

Identifies and manages existing and emerging risks that stem from business activities and the job role. Ensures risks associated with business activities are effectively identified, measured, monitored, and controlled. Follows written risk and compliance policies, standards, and procedures for business activities. Assists with the identification and investigation of suspicious financial and non-financial activity using multiple fraud management tools and systems. Initiates contact with members to review suspicious activity and escalates to team mitigation members when necessary to take appropriate actions to mitigate the risk and protect the member’s assets. Develops multi product, system, and/or process knowledge to detect and mitigate fraudulent activity across a variety of products and services. Learned to utilize appropriate fraud reporting tools and procedures to report confirmed fraud. Acquires and applies foundational knowledge of business, its products, and processes and provides improvement opportunities and recommended solutions to improve the effectiveness or efficiency of fraud prevention and detection. Familiarity and continuous utilization of KC for all steps and procedures necessary for call. Bank Sales and Service Contact Center Representative USAA FSB Bank December 2021- June 2021

Provides operational support to members with their banking needs on a single Banking product. Reviews accounts and processes transactions that may require regulatory action. Explores member’s banking needs and responds with needs-based solutions which includes opening and closing of banking products. Knowledge in account styling and standards. Recommends new Banking products that might be of interest to the member. Discussing funds availability, deposit holds, disputes of charges, requesting limit increases on cards, add or delete travel notifications, order new or replacement cards and checks at members requests. Assist members with funds transfers, discussing NSF fees and adjustments, assisting members with Bill Pay services, Zelle transactions and Deposit @ mobile options. Online access issues and resets. ATM/Debit card maintenance, Overdraft protection, ATM deposit disputes and inquiries. Sending of member statements at member’s request. Process debit card and ATM disputes. Add or remove stop payments of checks on accounts, as well as stopping payments on recurring Debit card transactions. Updates members account information on various bank products that include credit cards and deposits. Overall performance of maintenance, research, and resolution of members accounts. Knowledge of laws, rules, and regulations to include Reg E, Reg Z and state and Federal regulations and policies. Familiarity and continuous utilization of KC for all steps and procedures necessary for call. Ensures risks associated with business activities are effectively identified, measured, monitored, and controlled. Identifies and manages existing and emerging risks that stem from business activities and the job role. Maintains high levels of member satisfaction and demonstrates commitment to quality through member interactions.

USAA Classification: Internal

Remote Radiology Scheduler MRI Scan & Imaging Center December 2020 to November 2021

Remotely answer continuous, incoming calls from referring physicians, WC carriers, PIP/Attorneys, and patients to schedule radiology exams and route other calls appropriately. Pulls radiology orders from 3 systems and inputs or create patient files. Make outgoing calls to patients to schedule tests ordered. Knowledge of all preparations and restrictions for MRI, PET, CT scans and Ultrasound. Call or fax outside physicians and referring doctors. Review labs for upcoming tests and obtains all necessary documents needed for authorizations department. Remote Text, Fax, timeclock, messaging through Teams program with home site and other employees, email, and remote/soft phone communication daily. Work closely with management and techs for other assigned duties. Optical Technician Azzue Optometry

May 2016 to November 2020

Dispensing, repairing, and selling eye wear. Working with patients with insertion and removal of contact lenses, cleaning, and maintenance on contact lenses for first time users. Teching patient's, auto refract and Optos. Do full optical work up with patients. Assists with choosing frames, lenses, and additional add- ons. Explain all add-on options based on patient's needs, explain cost, and collect for services. Post charges and payments for all orders taken daily. Write up all patient orders and take appropriate measurements. Ordering and maintaining stock and working closely with outside frame and contact lens reps. Uploading all patient glasses and contact lenses orders through designated labs for start of job and follow-up until received. Accounts Payable. Answering phones. Making appointments. Pulling eligibility and other misc. front desk duties. Billing and Collections. Billing Specialist Trinity Spine Center

April 2014 to May 2016

Verify benefits for Physical Therapy and Chiropractic services. Call or fax for all needed authorizations to PCP or health insurance. Answer incoming billing calls to discuss patient balances or attorney questions. Work monthly A/R reports for each physician. Work claim denials, appeals and inquiries. Assist with clean-up after surgeries. Charge Entry and occasional payment posting PIP settlement requests, LOP requests and maintaining all info needed from attorneys. Handle all collection accounts. Work closely with CEO and Doctor's, outside physicians and attorneys as necessary with patient accounts, billing, itemized bills, settlements, etc.

Billing Specialist / Lead Payment Poster Rose Radiology Centers, Inc April 2011 to 2014

Performs all functions of insurance and patient payment posting. Collection of both patient and insurance balances. Answering incoming calls and assist with billing and attorney questions. Create daily posting batches from lockbox. Sort, calculate and balance deposited totals. Handled all aspects of training new employees on the system as well as training in the billing and collection procedures. Work assigned A/R's

(Humana, Cigna, Medicare, GHI, Care Plus and more) which included calling on denials, sending appeals, correcting claims, and account follow-up. Process Credit Card payments. Discuss and assist patient's in understanding their insurance plans, deductibles and out of pocket costs. Assist in setting up payment arrangements and offering pay in full discounts on outstanding balances. Verification of benefits and obtaining authorizations for service. Assist with attorneys in reduction requests and PIP payments. Work closely with administration staff to create new ideas that would benefit the department and revenue. Charge Entry. Watching for denial trends and monitoring outcome of performance on those trends. USAA Classification: Internal

Financial Counselor New Hope Cancer Center

September 2002 to October 2011

Interview each patient to verify if the information on file is still accurate. Discuss benefits, out of pocket costs, making sure all forms are signed and completed. Verification of benefits. Answering incoming billing calls. Help obtain co-pay assistance chemotherapy drugs and co-pays. Obtain authorizations for services. Write up and discuss financial plans and go over the options available for payment, drug assistance and outstanding balances. Worked closely with doctors and nursing staff for clarification of orders given and treatment planning. Radiation charge entry. Perform all functions of insurance and patient payment posting. Running of daily balance/ co-pay sheets and prepare for front desk staff for collection. Cover front lobby when needed for check-in, calling on denials, submitted appeals and account follow-up with patient accounts and insurance claims. Created and filed all insurance documents into financial charts. Schedule after hour or lunch in-services with drug representatives for staff and physicians. Handling of all collection of past due merged/outdated accounts, current balances, setting up monthly payment arrangements.

Education:

Diploma

Ridgewood High School - New Port Richey, FL

Programs Used:

Revolution EHR MS Office

Web MD MS Excel

Availity FDR

CMS CLASWORKFLOW

Teams Immadmin Tool

Slack ECIF Tool

Lexis Nexis Laps

Experian FAMT

RSA

RDC

Bridger

DMDC

SCRA

CC payment processing systems

THEA

E-cams

Safire

Achievements:

ABA Certification of Fraud Prevention

Contact this candidate