Data Entry Customer Service

KARIE SIMPSON

Professional Summary

To seek and maintain a full-time position that offers professional challenges utilizing interpersonal skills, excellent time management and problem-solving skills.

Skills

Insurance Claim Forms Review

Teamwork and Collaboration

Policy Modifications and Updates

New Policies Processing

Information Verification

Data Entry

Customer Service

Coverage Determination

Insurance Verification

Problem-Solving

Decision Making

Active Listening

Policy and Procedure Explanations

Time Management

Microsoft Office-training classes taken

10-Key Touch

Company specific systems EZ-Cap, MC400, Macess, 3M grouping, GIAS, Resonant, Sircon, Advantx, Conversant, Hal Screens, Netsmart, Waystar, eApp

Work History

AO-Globe Life 07/2024-present

Benefits Specialist

· Review and explain benefits available to members

· Analyze members gaps in coverage to assist using Needs Analysis

· Use company given leads to build additional leads for benefit reviews

· Licensed for Life and Health Insurance in the following states: AZ, CA, IA, WA

Connections Health Solutions 08/2023-07/2024

AR Collateral Specialist

· Reviewed all denied claims for possible resolution for resubmission

· Called Insurance Companies to inquire information regarding denials

· Write-off analysis

· Assisted teammates with questions on processing certain denials

· Review of applied insurance types and ensured accuracy with information loaded into system

· Behavioral claims specialist with outpatient and in-patient claims

USAA Life Insurance Company – Phoenix, AZ 11/2022 to 06/2023

Life Service Specialist

· Answered USAA member’s incoming calls

· Assisted with updating member’s informational profiles

· Assisted with incoming payments and updating automatic payments accounts

· Answered basic questions regarding life insurance and Medicare Supplement policies

· Routed calls to appropriate departments for further assistance as needed

· Worked closely with other departments to ensure member’s inquiry was satisfied and resolved

Chandler Endoscopy Center - Chandler, AZ 01/2022 to 9/2022

Insurance Verification Specialist

· Verified insurance eligibility and benefits prior to procedures

· Assisted with scheduling patients, collecting payments, and answering phones

· Called patients to review benefits

· Prepared charts for the next day’s patients

· Requested authorizations for procedures

Sagicor Life – Scottsdale, AZ 04/2019 to 01/2022

Policy Issue Assistant

· Reviewed, prepared and mailed out Life and Annuity policy pages

· Reviewed documents for transfer requests and sent out accordingly

· Reviewed incoming documents for accuracy to meet specific requirements

· Processed Not Taken, Decline and Withdraw letters

· Assisted with developing Processing Documents for the company

· Answered calls from agents, clients, as well as internal co-workers with questions regarding

policies

Abrazo Healthcare – Phoenix, AZ 07/2013 to 02/2019

Claims Examiner, Senior – 02/2015 – 02/2019

· Claims research and resolution

· Recoupment and adjustment research

· Review of all claim types (Professional, Hospital, Skilled Nursing, DME, Home Health)

· Worked on special projects

Subject Matter Expert (SME) 08/2014 to 02/2015

· Claims research and resolution

· Trained to process California claims

· Assisted with writing Policy and Procedures, Training Guides, and Job Aides for 67 different types

of plans

· Assisted with suggesting system updates and testing

Claims Analyst - 07/2013 to 08/2014

· Claims research and resolution

· Full knowledge and understanding of 87 different types of commercial health plans

· Assisted in writing Policy and Procedures, Training Guides

· Worked on special projects

· Assisted with working on the run-out of a commercial plan and the training for the take-over

company

Triwest Heathcare Alliance – Phoenix, AZ 01/2007 to 04/2013

Claims Analyst II

· Claims research and resolution for the Tricare benefit for the military

· Worked correspondence received by providers and beneficiaries

· Partnered with claims processor to assist with processing errors

· Recoupment and adjustment research

· Review of all claim types (High Dollar, Hospice, Skilled Nursing, Hospital, Professional);

· Worked with all departments to assist with projects (Program Integrity, Provider Services, TRICARE

field support, Medical Review, and Case Management)

· Assisted with new software implementation and training to employees

· Healthcare Audit

· Policy Implementation

· Assisted with developing Desk Procedures

Education

Associate of Science: Physical Therapist Assistant 05/2006

Gateway Community College - Phoenix, AZ

Health and Life Insurance License 07/2024

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