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Claims Specialist with 5+ years in healthcare and customer service
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Competencies
Expertise in analyzing, reviewing, and adjudicating healthcare claims in accordance with industry standards.
Proficient in applying CPT, ICD-10, and HCPCS codes for accurate claim review and reimbursement determination.
Handled customer inquiries and provided clear guidance on benefits, orders, and account issues.
Ensured HIPAA compliance in handling sensitive health and personal information across roles.
Supervised shift activities and coordinated team efforts to optimize store performance and customer satisfaction.
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Summary
Dedicated claims specialist with over 5 years of experience in healthcare claim adjudication, medical coding, and customer support. Skilled at ensuring compliance, accuracy, and quality in high-volume environments while maintaining excellent communication and problem-solving abilities.
Key Achievements
- Reviewed and adjudicated complex healthcare claims, ensuring compliance and accurate payments at HCS Corporation.
- Processed high-volume claims efficiently, resolving discrepancies and maintaining quality standards at Kelly Services.
- Provided customer support, guiding members through benefit inquiries and order processes at ResultsCX.
Experience
Sr. Claims Representative
Analyze and adjudicate complex healthcare claims for Blue Cross Blue Shield members, ensuring compliance with plan benefits, regulatory standards, and provider agreements., Conduct detailed reviews of medical billing codes (CPT, ICD-10, HCPCS) to determine appropriate reimbursement and claim...
Claims Technician
Process and adjudicate high volumes of medical claims in accordance with health plan policies, CMS guidelines, and provider contracts., Investigate and resolve complex claim issues, including coordination of benefits, billing discrepancies, and provider inquiries., Interpret medical coding (CPT,...
Call Service Representative
Handled high-volume inbound calls while providing clear guidance on benefit eligibility, product availability, and order placement., Resolved customer issues related to orders, benefit balances, product substitutions, and delivery concerns., Maintained HIPAA compliance and data privacy standards...
Shift Leader
Supervised shift operations by coordinating team members, delegating tasks, and ensuring efficient store performance., Provided excellent customer service by resolving customer concerns and ensuring a positive guest experience., Managed cash handling, register operations, and end-of-shift...