Customer Service Support

Toni Davis

****.******@*****.*** 443-***-**** Remote, Delaware

Professional Summary

Detail oriented claims processing professional with expertise in customer service, provider support, and case adjudication. Skilled in resolving provider inquiries, processing claims, and ensuring compliance with contractual agreements. Seeking a remote claims processing role to apply experience in adjudication and case management.

Experience

AmeriHealth Provider Support Claims Adjudicator (Contract) 03/2023 – 05/05/2025 Remote

Resolve provider inquiries on benefits, eligibility, and claims processing.

Review, adjudicate, and reconcile claims (CMS 1500, UB 04, ICD 10) per guidelines.

Conduct audits and reconcile discrepancies for timely resolution. UnitedHealth Group Customer Service Advocate (Contract) 03/2021 – 03/2022 Remote

Processed medical, dental, and vision claims; ensured compliance with Medicaid/Medicare.

Provided coverage and pricing explanations for prescription drugs.

Assisted with appointment scheduling and resolved member inquiries. TTEC/Bank Of America Remote Customer Support Agent (Contract) 06/2020 – 03/2021 Remote

Handled inbound inquiries regaring account balances, transactions and online banking support.

Assited customers with fraud claims, payment disputes, and account security.

Responsible for troubleshoooting technical issues and escalation cases. Skills

Type 60 WPM Proficient in Case Management Software Conflict Management 1

Time Management Self Starter Data Analytics Proficient with Slack, MicroSoft Teams, and Zoom.

Certifications

Coursera by Google: IT Professionals Certification – Completed: 2024 Zen Desk: Customer Service Agents Case Management – Completed: 2023 Zen Desk: Administrators Team Lead Role – Completed: 2023 2

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