I am a customer-focused professional with more than 10 years of experience resolving complex account, billing, claims, payment, and insurance issues across financial services, healthcare, and insurance environments.
I specialize in assessing customer needs, interpreting insurance policies and benefits, processing claims and payments, and translating complex billing or coverage information into clear, actionable solutions.
My experience includes insurance verification, claims processing, benefit and premium calculations, accounts receivable, payment reconciliation, fraud investigation, and high-volume customer account management.
I am skilled at maintaining accurate records in CRM and operational systems, preparing reports, coordinating with cross-functional teams, and meeting quality, compliance, productivity, and turnaround-time requirements.
I bring strong problem-solving, conflict-resolution, communication, and multitasking abilities. I am comfortable working with customers, healthcare providers, insurers, financial institutions, clinical specialists, compliance teams, and internal stakeholders to resolve escalated issues.
I am currently working as a seasonal licensed life, health, and annuities agent and am open to opportunities where I can apply my customer service, claims, insurance, and account-resolution experience.
Processed new medication orders and refills, including insurance verification and benefit reauthorization.
Entered prescription and billing data accurately into pharmacy systems while maintaining compliance requirements. Communicated with healthcare providers and insurance companies to resolve billing and payment issues, maintained detailed patient and account records, and supported financial and clinical performance targets.
Evaluated eligibility for long-term disability benefits and calculated benefit amounts, offsets, and taxes. Gathered and reviewed confidential medical and financial documentation to support claim and payment decisions.
Communicated claim statuses, balances, and decisions through clear written correspondence. Collaborated with clinical and vocational specialists as well as appeals and legal teams to resolve escalated accounts.
Reviewed transaction alerts and potential fraud cases involving account takeover, card fraud, check fraud, and scams. Investigated cases using internal systems, member history, and external data sources.
Contacted members to verify activity and provide account-protection guidance. Made timely decisions to approve, decline, hold, or escalate transactions and documented findings for audit and regulatory purposes.
Identified emerging fraud trends and recommended process or rule improvements. Collaborated with Risk, Compliance, and law-enforcement liaisons while meeting quality, productivity, and turnaround-time goals.
Managed national client accounts and maintained CRM information, including pricing, billing contacts, and service details.
Produced billing and account reports, analyzed customer data, and supported contract compliance and client satisfaction. Served as a liaison between customers and internal teams to support contract negotiations and account resolution.
Processed and resolved insurance claims by reviewing policy coverage and investigating discrepancies.
Collaborated across departments to support fair and accurate settlements while maintaining comprehensive claim and account records.
Handled high-volume payment processing with strong accuracy and attention to detail.
Reconciled discrepancies, ensured timely updates in financial systems, supported audit readiness, and coordinated with teams to maintain smooth and accurate payment operations.
Master of Business Administration, Healthcare Management
In progress.
Bachelor's in University Studies, Business Management
Focus in Business Management.
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