Rachel Goins
Baton Rouge
Summary
Experienced with thorough investigation and assessment of insurance claims. Utilizes critical thinking and detailed analysis to ensure fair and timely settlements. Track record of strong understanding of regulatory compliance and effective communication with stakeholders.
Overview
18
18
years of professional experience
Work History
Customer Service Representative
Louisiana Lottery Corporation
08.2024 - Current
- Ensured claims integrity by applying lottery rules and procedures effectively.
- Resolved player claim issues through effective communication via phone and mail.
- Supported regional claims personnel with assistance and necessary information.
- Secured pending claims by tracking original documents and computer logs meticulously.
- Executed additional departmental duties as assigned by supervisors promptly.
- Applied lottery regulations to ensure accurate prize payments and claims processing.
Temporary Team Lead: Claims Examiner
Jacobson Online
01.2022 - 10.2023
- Enhanced employee performance through targeted coaching and development initiatives.
- Executed plans promoting employee engagement and achievement across the team.
- Created effective schedules and delegated daily tasks to optimize workflow.
- Monitored staff performance, ensuring adherence to quality and productivity standards.
- Identified cost-saving opportunities while managing operational expenses effectively.
- Analyzed claims to guarantee compliance with filing requirements and standards.
Temporary Claims Processing
Jacobson Online
04.2021 - 12.2021
- Process claims in accordance with provider contract and member benefits
- Process and adjudicate claims based on knowledge coverage and the provider contracts
- Process and adjudicate Medicare and Medicaid claims
- Collaborate with my team members to proactively address service issues and concerns
Temporary Team Lead: Claims Processing/Customer Service
Jacobson Online
09.2019 - 11.2020
- Enhanced team performance by supervising a 60-member workforce effectively.
- Streamlined employee onboarding through targeted interviews and comprehensive training programs.
- Elevated employee competencies through focused coaching and performance development strategies.
- Implemented engagement initiatives to boost employee satisfaction and achievement.
- Optimized task delegation by creating efficient schedules and assigning daily responsibilities.
- Ensured compliance by analyzing claims and updating necessary line items promptly.
Cashier & Customer Service Rep
Walmart
05.2019 - 10.2019
- Greeted customers
- Scanned products
- Applied discounts and processed coupons
- Processed payments, returns and exchanges
- Assisted customers with questions or concerns
Temporary Medicare Regulatory Analyst
Jacobson Online
09.2018 - 03.2019
- Achieved compliance by investigating filings for regulatory agencies across jurisdictions.
- Coordinated escalated complaints for CMS Medicare Advantage and Prescription Drug Plans effectively.
- Led successful conversion project for medical malpractice data from finance to claims department.
- Submitted marketing materials and member information to enhance customer service processes.
- Ensured 100% compliance with state, federal, and territorial regulatory requirements.
Temporary Electronic Intake Coordinator
Randstad Staffing
05.2018 - 09.2018
- Researched and reviewed demographic, financial, medical and other pertinent data required to initiate intake process
- Monitored various intake sources such as faxes, clip boxes, electronica referral services and discharge planning
Temporary Electronic Intake Coordinator
Aerotek Staffing
03.2017 - 09.2017
- Facilitated patient intake by researching demographic and medical data.
- Monitored intake sources, ensuring prompt processing of referrals and documentation.
- Processed preliminary referral paperwork to expedite admission and intake procedures.
- Reconciled missing data reports, improving accuracy and efficiency of records.
- Input faxed and electronic referrals into financial systems for timely processing.
- Scheduled patient encounters within five minutes to enhance admissions workflow.
Temporary Senior Claims Examiner & Senior Marketing Administrator
Jacobson Online
07.2016 - 12.2016
- Verified and documented enrollment information using online Medicare systems.
- Processed Medicare Supplement claims efficiently to ensure timely reimbursements.
- Resolved claims inconsistencies, enhancing accuracy and efficiency in processing.
- Handled escalated concerns promptly, improving provider and customer satisfaction.
- Coordinated research on supplier fees and inspections, ensuring compliance with regulations.
- Maintained accurate provider enrollment data, adhering to CMS application timelines.
Team Lead: Adjustment Specialist
Blue Cross Blue Shield of Louisiana
02.2008 - 01.2014
- Assigned tasks and monitored daily operations
- Trained new employees
- Processed provider and physician reimbursements according to policy payments and coding methodologies
- Investigated and resolved program data or technical issues
- Processed recoupment of payments
- Processed insurance audits and payer claims
Education
Associate of Applied Science - Business Management
Remington College
Baton Rouge, LA11-2009
High School Diploma -
Baker High School
Baker, LA05-2000
Skills
- AIM
- Amisys
- Avaya
- BlueSquare
- Citrix
- Deltek
- Eloquence
- EPIC
- Facets
- IPD
- Java
- Macess
- Microsoft Office
- Sharepoint
- VMWare
- Xcelys
- 10-key
- Adaptable
- Collaborator
- Data entry
- Excellent verbal and written communication
- ICD-10
- Leadership
- Medical terminology
- Multi-tasker
- Planner
- Problem-solver
- Switchboard
Timeline
Customer Service Representative
Louisiana Lottery Corporation
08.2024 - Current
Temporary Team Lead: Claims Examiner
Jacobson Online
01.2022 - 10.2023
Temporary Claims Processing
Jacobson Online
04.2021 - 12.2021
Temporary Team Lead: Claims Processing/Customer Service
Jacobson Online
09.2019 - 11.2020
Cashier & Customer Service Rep
Walmart
05.2019 - 10.2019
Temporary Medicare Regulatory Analyst
Jacobson Online
09.2018 - 03.2019
Temporary Electronic Intake Coordinator
Randstad Staffing
05.2018 - 09.2018
Temporary Electronic Intake Coordinator
Aerotek Staffing
03.2017 - 09.2017
Temporary Senior Claims Examiner & Senior Marketing Administrator
Jacobson Online
07.2016 - 12.2016
Team Lead: Adjustment Specialist
Blue Cross Blue Shield of Louisiana
02.2008 - 01.2014
Associate of Applied Science - Business Management
Remington College
High School Diploma -
Baker High School