Data Entry Claims Adjuster

DEVIN WATSON-SMITH

El Mirage, AZ • 623-***-**** • *************@*****.***

Motivated and detail-oriented High Dollar Claims Adjuster with over 5 years of experience in health insurance claims processing, data entry, and payment management. Seeking to bring my expertise to a dynamic company. Eager to contribute my proven expertise to enhance team performance, and support organizational goals, while continuing to grow professionally in a collaborative, forward-thinking environment.

PROFESSIONAL EXPERIENCE

Redirect Health - Phoenix, AZ August 2023 – Present High Dollar Claims Adjuster and Contracting Specialist (Promotion)

• Achieved a 90% success rate in negotiating single agreements to reduce member out-of-pocket costs, ensuring affordability while maintaining alignment with organizational goals and compliance standards

• Developed and delivered comprehensive Explanation of Benefits (EOB) reports for members, provided clear explanations of claim resolutions and member responsibilities

• Built and maintained relationships with hospital systems and internal stakeholders to support business needs

• Assisted with the development and implementation of a more efficient process for utilizing a deductible accumulation tool, improving accuracy and streamlining workflows to enhance member experience and operational efficiency

• Collaborated with C-suite and D-level internal stakeholders to address escalations, provide project updates, and ensure alignment with organizational priorities and strategic goals

• Owned and managed escalations through App ticketing system, ensuring timely resolution, effective communication with stakeholders, and consistent tracking to improve service delivery and customer satisfaction

Claims Examiner/Payment Specialist September 2021 – August 2023 (Promotion)

• Managed and adjusted health insurance claims, ensuring accurate processing and adherence to company policies

• Maintained a high level of accuracy and attention to detail while handling claims volumes in a fast-paced environment

• Collaborated with providers to resolve claims appeals, clarifying payment determinations and addressing inquiries

Redirect Health - Phoenix, AZ March 2021 – September 2021 Data Entry Claims Specialist

• Processed and entered claims data accurately into the system, ensuring quick and efficient claims resolution

• Verified information on claims submissions, identifying discrepancies and working with other departments to rectify errors

• Logged and tracked receipts to ensure accurate documentation and processing of member transactions.

• Determined eligible out-of-pocket expenses and assessed which would apply to deductible calculations, ensuring compliance with policy guidelines.

• Manually created deductible accumulation reports, maintaining accuracy and consistency in tracking deductible progress for members.

Albertsons Companies, Phoenix, AZ February 2018 – March 2021 Payroll Specialist/Associate Experience Specialist

• Maintained a high level of professionalism while handling sensitive employee data and issues

• Provided training and support to new team members, ensuring high-quality service and problem resolution

• Provided exceptional customer service by promptly addressing payroll-related inquiries and resolving employee concerns regarding paychecks, deductions, and benefits.

• Assisted employees with payroll discrepancies, ensuring accurate resolutions and maintaining high levels of employee satisfaction.

• Educated employees on payroll policies and procedures, including tax withholdings, direct deposit setup, and benefit deductions.

• Collaborated with payroll and HR teams to investigate and resolve escalated issues, ensuring compliance with company policies and legal requirements.

• Maintained detailed records of employee interactions, documenting resolutions and identifying trends to recommend process improvements

PayPal, Phoenix, AZ March 2016 – February 2018

Collections Specialist

• Managed collections efforts for delinquent accounts by contacting customers via phone, email, and automated systems, securing timely payments

• Analyzed account histories to identify overdue balances, assess risk levels, and recommend appropriate collection actions

• Negotiated payment plans and settlement agreements with customers, achieving high recovery rates while maintaining positive customer relationships

• Educated customers on account balances, payment options, and financial obligations, ensuring clarity and resolution of disputes

• Resolved escalated issues related to billing errors, fraud claims, and account discrepancies, collaborating with internal departments to find solutions

• Maintained compliance with regulatory guidelines and company policies, ensuring ethical collection practices

• Documented all customer interactions and collection activities in the company’s CRM system, ensuring accuracy and adherence to data privacy standards

• Monitored account statuses and identified opportunities for early intervention to prevent accounts from becoming delinquent

• Achieved monthly and quarterly collection targets, consistently exceeding performance benchmarks and contributing to team goals

EDUCATION

Willow Canyon High School, Surprise, AZ – 2012

SKILLS

Communication Skills Problem-Solving Time Management Team Collaboration Adaptability Attention to Detail Conflict Resolution Leadership Customer Service

Technical Proficiency (eClinicalWorks, Microsoft PowerApps, JIRA, Zendesk, Excel, Word, Adobe)

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