Remote Customer Service rep/ insurance claims

Marielle Michel

Palm Bay, Florida ***** 321-***-**** ************@*****.***

Skills

Emergency response

Insurance verification

Claims

Regulatory compliance

Data entry proficiency

Month-end closing

HIPAA compliance

Claim

Multitasking and organization

QuickBooks proficiency

Multitasking Abilities

Problem solving

Effective communication

Team collaboration

Self motivation

Professionalism

Excellent communication

Insurance claims representative, 03/2022 - 10/2023

NSI Insurance Group – Fort Lauderdale, Florida

Prepared reports summarizing claim activity for senior management review.

Reviewed customer insurance claims to ensure accuracy and completeness of information.

Participated in training sessions conducted by insurers on new products and services.

Resolved customer complaints related to insurance claim processing.

Ensured compliance with state laws governing insurance practices as well as company policies and procedures.

Processed requests for additional documentation from customers in a timely manner.

Analyzed claim records, policy provisions, and other relevant documents to determine validity of claims.

Monitored reports to identify claims issues and worked with adjusters to resolve problems.

Supported efficient handling of complex claims and followed up on open, denied, or suspended claims to complete required line items.

Called insurance companies to ascertain pertinent information regarding policies and payment benefits for patients.

Retained strong medical terminology understanding in effort to better comprehend procedures.

Handled billing related activities focused on medical specialties.

Corresponded with insured or agent to obtain information or inform of account status or changes.

Handled modification and updating of policies.

Prepared and reviewed insurance-claim forms and related documents for completeness.

Assisted new policyholders with processing claims.

Customer Support Specialist/Remote, 07/2019 - 06/2022

Road America – Melbourne, FL

Created detailed reports on customer feedback for management review. Inbound calls, solving customers issues.

Researched customer inquiries using available resources such as FAQs and online forums.

Followed up with customers after issue resolution to ensure their satisfaction with the outcome.

Assisted customers with product installation, troubleshooting, and usage questions.

Assisted customers in obtaining tow trucks when needed using GPS navigation systems or other resources.

Checked and maintained roadside assistance vehicles, ensuring they are clean, fuelled and in working order.

Responded promptly to all service requests, providing outstanding customer service at all times.

Conducted regular inspections of roadside equipment such as flares, fire extinguishers and first-aid kits ensuring they are in good condition.

Inspected customer vehicle for any mechanical problems and provided emergency repairs when necessary.

Assisted customers with flat tire changes and jump starts of dead batteries.

Tracked and reported on service delivery metrics to improve response times.

Managed sensitive customer information with confidentiality and care.

Educated customers on safety protocols while waiting for roadside assistance.

Coordinated with insurance companies for service coverage verification.

Assisted customers via phone with troubleshooting minor vehicle issues.

Utilized GPS tracking systems to optimize service provider dispatch.

Managed a high volume of emergency calls with professionalism and empathy.

Resolved customer complaints and issues in a timely and effective manner.

Medical Claims Specialist, 06/2010 - 06/2015

Wuesthoff Medical Center – Melbourne, Florida

Assisted with setting up dining areas prior

Processed appeals on rejected or partially paid claims, including filing additional paperwork as needed.

Responded promptly to customer inquiries regarding claim status updates.

Verified patient eligibility for medical claims and determined benefit coverage.

Conducted research into complex medical coding issues to ensure proper reimbursement.

Maintained accurate records of all claim activities for audit purposes.

Reviewed denials, rejections, and underpayments from insurance carriers.

Resolved issues related to denied or underpaid claims in a timely manner.

Reviewed claims for accuracy before submitting for billing.

Accurately processed large volume of medical claims every shift.

Stayed current on HIPAA regulations, benefits claims processing, medical terminology and other procedures.

Called insurance companies to ascertain pertinent information regarding policies and payment benefits for patients.

Handled modification and updating of policies.

Prepared and reviewed insurance-claim forms and related documents for completeness.

Billing Specialist/Assistant Team Leader, 05/2004 - 04/2010

Greater Heart group/ WBMC – Boca Raton, Florida

Reviewed medical records to ensure accuracy of billing information and patient data.

Performed additional duties as assigned by management team.

Verified insurance coverage and identified third-party payers for billing purposes.

Performed data entry into accounting software programs such as QuickBooks.

Calculated billing charges, prepared and submitted claims to insurance companies.

Investigated incorrect billings and processed refunds as necessary.

Answered customer inquiries regarding billings, payments, account status.

Investigated past due invoices and delinquent accounts to generate revenues and reduce number of unpaid and outstanding accounts.

Collected, posted and managed patient account payments.

Accurately input procedure codes, diagnosis codes and patient information into billing software to generate up-to-date invoices.

Performed insurance verification, pre-certification and pre-authorization.

Maintained accounting ledgers by verifying and posting account transactions.

Checked claims coding for accuracy with ICD-10 standards.

Answered customer questions to maintain high satisfaction levels.

Entered procedure codes, diagnosis codes and patient information into billing software to facilitate invoicing and account management.

Trained new team members on company policies and accounting systems to keep team operations productive and efficient.

Submitted claims to insurance companies.

Enforced compliance with organizational policies and federal requirements regarding confidentiality.

Activities and Honors

Summary

Experienced Insurance Claims Representative with robust knowledge of insurance policies, claims handling procedures and regulatory compliance. Skilled in negotiating claim settlements and managing large case loads with accuracy and efficiency. Demonstrates strong interpersonal skills for customer service and team collaboration, contributing positively to work environment and client satisfaction.

Education

License: Adjuster, 09/2024 - 02/2025

Adjusterpro - Palm Bay, FL

06/2001

Stoneman Douglas High School - Coral Springs, Florida

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