Claims & Customer Service Specialist
Resume:
Geneva Daniels
Detroit, MI *****
**************@*****.***
Professional Summary
Authorized to work in the US for any employer
Authorized to work in the US for any employer
Work Experience
Associate General Clerk/Contract Position
Highmark Health Remote-Pittsburgh, PA
October 2025 to January 2026
• Upload documentation for member questionnaire's, which are submitted for annual government survey's.
• Used EMR system such as AHN, LVHN, Wellspan, and St. Luke's systems with over 2000 members.
• Run all downloaded documentation with a BOT AI run system to capture all important questions for 2025 survey.
• Use PowerPoint, Microsoft and Excel to keep track of documentation implemented in systems while submitting 2025 for survey's based of government guidelines and policies in a three month span for contract.
Customer Service/Claims Examiner
Firstsource with Molina/Aetna Medicaid and Medicare-Michigan March 2022 to July 2025
• Answered inbound calls with inquiries about the customers account/billing inquiries, DME orders, etc.
• Use multiple systems and screens, set up transportation to doctors appointments, send replacement medical I'd cards, and submit provider claims in a timely matter.
• Submit corrected claims, reverse claims, adjust claims, call tracking, using UB and 1500 forms. Knowledge of CPT coding to ensure payments on claims are accurate.
• AEP Enrollment, SEP Enrollment, IEC Enrollment, file Agent SOA Commission Payments. Enroll members Medicare and Medicaid applications in a timely manner.
• Experience in working IP and OP claims, CPT code knowledge, LTSS claim knowledge. experience in Resubmission claims, adjustments and call tracking.
• Also did medical health appeals and greviences.
Customer Service Representative
Willis Towers Watson-Southfield, MI
August 2021 to March 2022
• Answer Medicare questions and enrollment.
• Handle reimbursement accounts, reissue checks, answer general questions, escalate and de-escalate calls.
• Deal with upset customers about their reimbursement accounts, troubleshooting tips on how to get on their online accounts, etc.
Inspector/Packer
AUTOMOTIVE QUALITY & LOGISTICS-Detroit, MI
July 2018 to March 2019
• Inspect all parts thoroughly with marker and mark all points checked.
• Pack each part in a timely matter for shipments, make sure paperwork is filled out properly as well. Production Worker
Mastnardi Produce-Livonia, MI
April 2017 to July 2018
• Pick and package product in an efficient matter on time for pick up.
• Assist supervisor and line lead with daily inquiries and product handling also check for quality. Kroger Cashier
Kroger Stores-Dearborn, MI
February 2015 to April 2017
Assist customers with checkout, bagged groceries, stocked shelves if needed, also did a little housekeeping.
Customer Service Representative
AT&T - Prime Communications-South Field, MI
August 2010 to February 2015
Answer inbound and outbound inquiries or sales, assist customers with the best customer service experience, answer all questions in a promptly matter, using internet, via email and or chat, faining, filling, printing, photocopying, data entry, etc.
Security Officer
G4S Secure Solutions-Scottsdale, AZ
May 2006 to August 2010
Check in trucks and vehicles entering and exiting the property, foot patrols, report writing, surveillance, parking lot patrols, etc.
Housekeeping Supervisor/Inspector
Pollo Towers-Scottsdale, AZ
June 2003 to May 2006
Inspect all rooms before booking in a timely matter, make sure all rooms are clean throughout efficiently, supervise all housekeeping staff in an professional matter. Education
Medical Administrative Assistant (Certificate)
Everest University
January 2014 to January 2015
General Studies (High school diploma or GED)
Mcclintock High School/Compadre-Tempe, AZ
August 1999 to May 2003
Associate's degree
Skills
• Administrative experience
• Non-technical user support
• Appointment scheduling
• Copper CRM
• Live chat
• Health insurance verification via real-time eligibility check
• Research
• Problem-solving
• Pricing
• Microsoft Excel
• Customer complaint resolution
• Calendar management
• Healthcare provider information
• Phone call management
• Front desk
• Medical Coding
• Medical terminology
• Customer support experience within healthcare industry
• Interpersonal skills
• Critical thinking
• Providing product information
• Client email correspondence
• Communication skills
• Managing customer accounts
• Medicaid
• Productivity software
• Typing
• Medical administrative support
• Health insurance verification via manual review
• Solution development
• HIPAA
• Customer support specialist experience
• Bilingual
• Anatomy knowledge
• Technical support
• Analytical thinking
• Customer relationship management
• Customer support experience within telecommunications industry
• Improving customer support response time - Customer support response time improved (More than 30%)
• Medical claims
• Empathy
• Google Workspace
• Home health
• Email customer support
• Google Suite
• EDI
• Insurance claim processing
• Inpatient
• Customer satisfaction surveys
• Google Docs
• Teamwork
• Word processing
• Underwriting
• Multitasking
• Call center agent experience
• International customer service experience
• Health information management
• Experience in non-profits
• Working with people with disabilities
• Spanish
• Computer literacy
• CPT Coding
• Hospice
• Customer support - Customer support experience (6-10 years)
• DRG
• Windows
• Medical Billing
• Achieving HIPAA compliance
• Microsoft Teams
• Medicare
• Medical Office Experience
• Working with high schoolers
• Databases
• Document review
• Organizational skills
• SharePoint
• Medical records
• 5G
• Outpatient
• Search engines
• Time management
• Maintaining patient confidentiality
• Accounting
• Health insurance verification via electronic systems
• Technical Proficiency
• Phone customer support
• Health insurance information
• Client interaction via phone calls
• Office experience
• EHR systems
• Health insurance verification via paper documents
• Phone etiquette
• Salesforce
• Financial software
• Order processing
• Insurance claim appeals processing
• Healthcare management
• Computer skills
• Accounts receivable
• Analysis skills
• Medical collection
• Medical Scheduling
• Technical support representative experience
• Government agency customer support
• Healthcare support
• CRM software
• Documentation review
• ICD coding
• Internal audit for claims
• Scripting
• Medicare regulations
• Phone answering
• Managed care
• Health insurance knowledge
• Phone communication
• Remote access software
• CMS regulatory compliance
• Microsoft Powerpoint
• ICD-9 and ICD-10 (2 years), Assembly Line (2 years), Call Center (5 years), Customer Care (5 years), Customer Support (5 years), Customer Service (10+ years), Customer Care (5 years), Customer Support (5 years), Call Center (5 years), Customer Service (10+ years)
• Written communication
• Help desk
• Google Sheets
• Escalation handling
• State healthcare regulations
• Microsoft Access
• Customer inquiry handling
• Salesforce Cloud
• Computer operation
• Medical claim appeals
• Insurance verification
• Ethernet
• AI
• Microsoft Outlook
• Electronic health records (EHR) management
• Order inquiry handling
• Behavioral health
• Customer interaction metrics
• Medical Records
• Medical claims processing
• EMR systems
• Centers for Medicare and Medicaid Services (CMS)
• Clerical experience
• Billing issue inquiries
• Anesthesiology
• Management
• DME
• Attention to detail
• Data management
• Leadership
• Microsoft Office
• Microsoft Word
• Customer support experience within government industry
• Customer service
• English
• Customer feedback analysis
• Dental terminology
• Health insurance
• Project management - Project management experience (1-2 years)
• Pegasystems
• Outbound calling
• Regulatory compliance in claims processing
• FMLA
• Adobe Acrobat
• CRM system proficiency
• Technical user customer support
• HIPAA compliance management
• Patient service
• HCPCS
• Grammar Experience
Certifications and Licenses
medical administrative y
January 2015 to Present
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