Senior Claims Representative Remote Expert in Compliance and Claims

Kahlil A. Floyd

Philadelphia, PA ***** 267-***-**** ***************@*****.***

Professional Summary

Detail-oriented Senior Claims Representative with 2 years of remote experience at Cigna, specializing in claims processing, customer support, and complex problem resolution. Proven ability to analyze benefits, interpret policies, ensure regulatory compliance, and deliver high-quality service in fast-paced virtual environments. Strong communication skills, technical proficiency, and commitment to accuracy. Seeking a remote role that leverages analytical skills, client support expertise, and operational efficiency.

Skills

• Medical & Insurance Claims Processing

• HIPAA Compliance & Confidentiality

• Customer Service & Conflict Resolution

• Policy Interpretation & Eligibility Verification

• Data Entry & Accuracy Auditing

• Microsoft Office & Claims Management Software

• Remote Work Efficiency & Time Management

• Problem-Solving & Critical Thinking

Professional Experience

Cigna – Senior Claims Representative (Remote)

2023 – 2025

• Processed high-volume medical, dental, and pharmacy claims with 98–100% accuracy.

• Reviewed Explanation of Benefits (EOBs), provider documentation, and policy guidelines to determine claim outcomes.

• Resolved claim issues through direct communication with providers, members, and internal departments.

• Investigated discrepancies, performed root-cause analysis, and escalated complex cases as needed.

• Ensured compliance with federal/state regulations, including HIPAA and insurance standards.

• Consistently exceeded performance benchmarks including call quality, productivity, and turnaround time.

• Utilized multiple systems simultaneously in a remote environment while maintaining confidentiality and efficiency.

The Plum Pit Marcus – Line Cook

2015 – 2016 Hook, PA

• Prepared and cooked menu items while ensuring quality and consistency.

• Maintained clean, safe, and organized kitchen workstations.

• Followed food safety and sanitation guidelines.

Zips Dry Cleaners – Cashier/Tagger

2016 – 2017 Jenkintown, PA

• Handled customer transactions and operated POS systems.

• Tagged, organized, and prepared garments for cleaning.

• Provided customer service and ensured accuracy of orders.

LEAP TLA – Teen Leader Assistant

2017 – 2018 Philadelphia, PA

• Supported children in developing literacy and academic skills.

• Guided students in using library resources for homework and projects.

• Maintained a safe and engaging learning environment.

Education

Orleans Technical College – Residential & Commercial Electricity Diploma

Philadelphia, PA Completed Coursework

Completed hands-on training in electrical systems, wiring, troubleshooting, motor controls, PLCs, and blueprint interpretation.

Samuel Fels High School – High School Diploma

Philadelphia, PA 2018

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