Cheyenne S.
Mid-Level Disability Claims Specialist
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Cheyenne S. is a seasoned professional in the insurance industry, with extensive experience in disability and medical claims. Currently serving as a Disability Claims Specialist at Southwest Service Administrators Inc., Cheyenne expertly navigates complex claims processes, delivering efficient and accurate results. Previously, as a Medical Claims Analyst with Friday Health Plans, Cheyenne utilized expertise in ICD-9, CPT, and HCPCS coding to assess compliance under patient benefit plans. Her role demanded adherence to HIPAA privacy regulations and maintaining confidentiality while efficiently managing claims from Medicaid and specialty providers. As an independent Insurance Agent, Cheyenne excelled in customer service, building strong client relationships, and tailoring insurance solutions to individual needs. Cheyenne holds partial coursework towards an Associate in Science in Nursing and has specialized certifications, demonstrating a strong foundation in both practical and technical aspects of the health and insurance sectors.
Experience
Disability Claims Specialist
Southwest Service Administrators Inc. · 2023 — PresentProvided prompt responses to clients and offered clear explanations of policy terms while guiding them throughout the claims process. Collaborated with healthcare providers to gather essential information for more accurate claims decisions. Ensured attention to detail during medical record reviews to assess functional limitations caused by disabilities. Managed a high volume of disability claims, processing them promptly and accurately, while enhancing customer satisfaction through timely communication and empathetic support. Mentored junior members on complex case handling, fostering improved team performance and better decision-making.Medical Claims Analyst
Friday Health Plans · 2021 — 2023Analyzed incoming medical claims using ICD-9, CPT, HCPCS coding, and Medicare fee schedules to ensure compliance with patient benefit plans. Reviewed medical records for correctness in coding and modifiers to facilitate proper claims processing. Conducted research on medical claims issues by interpreting EOB's and claims history in response to inquiries. Billed insurance companies electronically and resolved EOB issues regarding payments. Entered and performed the adjudication process for HSA and FSA claims for employee payments, while adhering to Medi-Cal and Medicare regulations and maintaining HIPAA compliance.Insurance Agent
American National Insurance · 2016 — 2020Focused on maintaining high standards of customer service by building strong relationships with clients. Educated clients regarding the importance of proper insurance coverage, enhancing trust within the client base. Provided tailored insurance solutions to meet individual client needs, while actively prospecting for new business and generating referrals. Delivered prompt responses to inquiries from both prospective and existing clients. Developed extensive knowledge of various insurance products enabling effective recommendations based on client situations.Insurance Agent
Self-employed · 2016 — PresentEstablished long-term sources of clients by compiling prospect lists and determining clients' specific needs through fact-finding appointments. Developed coordinated protection plans by calculating and quoting rates for immediate and long-term coverage strategies. Communicated effectively with adjusters and obtained underwriting approvals by completing applications. Delivered policies and provided ongoing service by processing changes and analyzing policy loans. Ensured client needs were reassessed post-delivery of death benefits.
Skills & Expertise
Education
- Associate in Science (A.S.): NursingTrinidad State Junior College · — — 2021
- High School DiplomaSargent High School · — — 2008