Customer Service Claims Processor

Skill Set

Logistics

Coordination

Teamwork

Client Communication

Customer Service

Research

Problem Solving

Critical Thinking

Conflict Resolution

Leadership

Integrity

Flexibility

Experience

Mindlance- Claims Processor I C-2 Clearance, August 2025 – Present

Review and adjudicate complex, specialty, and deferral medical claims for military Tricare Family members.

Determine whether to return, deny, or pay claims following organizational policies and procedures.

Examine and process complex or specialty claims according to business/contract regulations and internal standards.

Enter claims into the claim system iFlow after verification of correct coding of procedures and diagnosis codes.

Research and resolve claim edits and deferrals.

Perform and research on claim problems by utilizing policies, procedures, and reference materials, while coordinating with various internal support departments.

Respond to routine correspondence and complete spreadsheets promptly.

Medical Document review

Caring Transitions of Myrtle Beach- Liquidator, January 2020 – July 2025

Decluttered homes to prepare for online auctions.

Photographed items for online auction listings with special attention to detail.

Responsible for obtaining product(s) clients purchased with detailed inventory

Provided excellent customer service and rapport with clients and family members.

Ivystone Apartments- Assistant Property Leaser, May 2018 – November 2018

Built positive relationships with prospective and current tenants

Supported the property leasing process by handling tenant inquiries

Coordinated property showings

Prepared and executed detailed and legally compliant lease agreements

Ensured accurate completion of all paperwork and contracts

Managed phone inquiries and documented all work orders

Travelers Insurance Company- Supervisor for Fraud Investigative Department, June 1984 – September 1997

Supervised teams of fraud investigators, ensuring cases are handled efficiently and effectively.

Oversaw the selection, direction, and performance of the team.

Manage and prioritize a large and varied caseload to ensure timely resolution.

Revised reports and investigative findings to ensure quality and thoroughness.

Lead, mentor, and guided a team of fraud investigators to enhance their skills and effectiveness.

Education

Greater Hartford Community College majored in accounting.

Eastfield College, Mesquite, TX, majored in accounting

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