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05/1998High School Diploma:South Grand Prairie High SchoolGrand Prairie, TXEMAIL AVAILABLEPHONE NUMBER AVAILABLENewark, TX 76071Skills Complex Problem Solving Property Owner Representation Coverage Assessment Client Interviewing Critical Thinking Active ListeningVerbal and WrittenCommunication Conflict Resolution Regulatory Compliance Team Collaboration Claim Form Analysis Complex Mathematics Claims Processing File and Record Management Research and Data Analysis Insurance Claim Regulations Report and Records Review Calm Under Pressure Fraudulent Claims Investigation Computer SkillsEducation And TrainingEnergetic and enthusiastic insurance professional motivated to succeed in fast-paced and deadline-driven professional environment. Comprehensive knowledge of claims adjustments with special knowledge of auto appraisals and CCC pathways estimations.Amazon - PackerHaslet, TX11/18/23 - 04/10/24Picking, pulling ordersQuality checking ordersPackaging orders for deliveryWarehouse environmentCVS/OMNICARE - Claims AdjudicatorGrand Prairie, TX10/2019 - 11/2022Prime Therapeutics LLC - Pharmacy TechnicianIrving, TX10/2013 - 06/2019Natasha MerrillSummaryExperienceNegotiated and settled claims according to information presented through reports, research and data verification.Processed and produced billing claims, while generating significant company savings.Performed insurance claims research to verify data and investigate reported information.Processed claims paperwork eiciently with in-depth research and top-notch communication skills. Worked closely with employees and managers at all levels. Entered claim transactions, payments, reserves and other documentation. Reviewed claims to ensure accuracy, resulting in multiple claim reductions. Completed required investigations on referred files within established timeframes. Researched and followed up on denied insurance claims. Evaluated evidence with ultimate goal of creating positive outcomes for client's claims. Investigated questionable claims to determine payment authorization. Leveraged database to confirm validity of prescriptions, patient data and drug side eects.Liaised with pharmacist to measure and prepare medication doses and packaging and label prescriptions.Maintained pharmacological practices by checking drug inventory, stocking medications and monitoring supplies.Flagged potential side eects and allergies to prescribed medications for patients.Teamed with peers, technicians and pharmacists to prioritize and complete orders. Verified prescriptions and drug labels, documents and packages. Refilled medications, oered insight into over-the-counter products and verified insurance benefits.Received and verified daily incoming drug inventories, reported discrepancies and logged items into inventory system.Improved inventory management procedures to reduce overhead, backorders and overstock.Assisted pharmacist with clearing high volume of prescriptions and responded to customer questions.Interpreted and processed medication orders under supervision of pharmacist. Prepared prescription transfers to other pharmacies. Inspected medication storage locations to monitor drug expiration dates and supply adequate inventory.Transmitted claims to insurance companies for payment and reconciled EOBs.Created new customer profiles and updated demographics, allergies and new medications in pharmacy computer systems.Greeted customers and answered questions regarding personal medications or over-the-counter pharmacy products.Monitored supply inventory and promptly submitted replenishment orders to prevent shortages.Checked medications for content, accuracy and completeness of drug packaging and labeling. Established or maintained medications and other patient profiles. Cleaned and maintained equipment or work areas according to prescribed methods. Mixed pharmaceutical preparations according to written prescriptions. Operated cash registers to accept payments from customers. Assisted customers by answering questions, locating items or referring to pharmacist for medication information.Ordered, labeled and counted stock of medications and entered inventory data into computer.Transferred medication from vials to sterile, disposable syringes using aseptic techniques. Prepared and processed medical insurance claim forms and records. Received and stored incoming supplies and informed supervisors of stock needs and shortages.Received written prescription or refill requests, verifying information for completeness and accuracy.Received written prescriptions and refill requests from patients, evaluating information for completeness and accuracy before filling.Prepacked bulk medicines, filled bottles with prescribed medications and typed and aixed labels.Computed charges for medication or equipment dispensed to hospital patients and entered data into computer.Communicated eectively with doctors and insurance agencies to resolve prescription cost discrepancies. Answered telephones to respond to questions or requests. Entered prescription information into computer databases. Maintained proper storage and security conditions for drugs.