Dental claims review specialist.

Quaeenkqua Woods

Trenton, NJ *****

Mobile: 609-***-****

***************@*****.***

Objective

Highly motivated claims/customer service professional seeking an opportunity to strengthen my business skills while contributing to the company’s positive reputation, operational, and customer/client service goals.

Highlights

- Self-motivated

- Extremely organized and efficient

- Able to quickly learn procedures and methods

- Strong computer experience; Internet, MS Office programs (Word, Access, PowerPoint, Outlook, Excel, and Adobe Acrobat) and a variety of other databases

- Capable of handling multiple projects simultaneously

- Excellent work ethics

Key Skills

- Legal Drafting & Legal Writing

- Legal Research & Correspondence

- Westlaw Certification

- Project Management

- Insurance & Claims Compliance

- Microsoft Office Suite (Word, Excel, PowerPoint, Outlook, Access)

- Adobe Acrobat

- Strong Organizational & Communication Skills

- Multi-tasking & Efficiency

Education

Mercer County Community College – West Windsor, NJ

Paralegal Studies (2018 – Present)

- Courses in legal research, litigation, contract law, and legal writing

Trenton Central High School – Trenton, NJ

High School Diploma (2006)

Professional Experience

P & R Dental Strategies – Hamilton, NJ

Dental Claims Review Specialist April 2016 – Present

- Evaluate and process dental insurance claims for accuracy and compliance with insurance policies.

- Serve as Lead Reviewer in the Texas compliance department and manage a small team of claims specialists.

- Train and mentor new team members on procedures, compliance guidelines, and claim evaluation standards.

- Conduct legal-style analysis of policy coverage to detect fraud and ensure regulatory adherence.

- Draft and manage correspondence between providers and consultants regarding claim disputes and clarifications.

- Coordinate and document phone conferences between dental consultants and providers.

- Utilize Westlaw certification to support legal research and decision-making related to complex insurance claims.

- Maintain up-to-date knowledge of insurance-related federal, state, and local policies.

Alloy, Inc. – On Campus Marketing – Ewing, NJ

Order Processor March 2015 – March 2016

- Reviewed and verified customer orders for accuracy, including product specifications, pricing, and delivery details.

- Prepared and circulated internal reports as well as generated and sent external reports to clients.

- Executed client-specific needs such as on-site distributions, emails, and phone notifications.

- Entered order data into the company’s system, ensuring all information was accurate and complete for processing.

- Generated invoices, shipping documents, and other necessary paperwork.

- Prepared orders for dispatch.

Contact this candidate