CHARDE' BENJAMIN
Hartsville
Summary
Detail-oriented Remote Claims Specialist with 7+ years of experience supporting medical claims processing, documentation review, and policy interpretation in high-volume, regulated healthcare environments. Proven ability to analyze complex claims, identify discrepancies, ensure adjudication accuracy, and consistently meet productivity and quality standards while working remotely. Experienced with manual and automated workflows, claims research, case resolution, and cross-functional collaboration while maintaining full HIPAA compliance.
Overview
8
8
years of professional experience
Work History
Healthcare Customer Service Representative (Claims Focused)
Blue Cross Blue Shield
04.2025 - Current
- Reviewed, researched, and resolved 40-60+ daily medical claims inquiries related to benefits, coverage determinations, billing accuracy, and claim outcomes.
- Analyzed claim history, policy provisions, and system data to identify discrepancies and processing errors.
- Ensured accurate claim documentation and system updates to support proper adjudication and downstream processing.
- Consistently met or exceeded production, accuracy, and quality benchmarks in a high-volume remote environment.
- Maintained strict HIPAA compliance while handling sensitive PHI and protected medical information.
Virtual Customer Service Associate - Healthcare (Claims Operations)
Staffing Solutions
Remote
08.2024 - 04.2025
- Supported healthcare members with claims status, benefit interpretation, and billing inquiries, ensuring accurate claim progression.
- Processed claim-related account updates and documentation with high accuracy across multiple healthcare platforms.
- Identified system errors, missing documentation, and inconsistencies affecting claim outcomes and escalated for resolution.
- Maintained service level, productivity, and quality standards in a fully remote environment.
Healthcare Specialist
CareCentrix
Remote
05.2018 - 08.2024
- Supported claims-adjacent workflows including authorization review, eligibility verification, and medical documentation validation.
- Reviewed clinical records and supporting documentation to ensure alignment with health plan guidelines and payer requirements.
- Collaborated with internal teams and external vendors to resolve processing delays, documentation issues, and workflow exceptions.
- Maintained compliance with healthcare regulations, payer policies, and internal quality standards in a remote environment.
Education
High School Diploma -
Wilson High School
Florence, SCSkills
- Medical Claims Review
- Claims Adjudication
- Policy and Plan Interpretation
- Manual Claims Processing
- Automated Claims Processing
- Claims Research
- Discrepancy Resolution
- CPT Coding
- ICD-10 Coding
- Medical Terminology
- Healthcare Billing Procedures
- Authorization Review
- Eligibility Verification
- Clinical Documentation Validation
- Quality Assurance
- Accuracy and SLA Standards
- HIPAA Compliance
- PHI Handling
- Remote Workflow Management
- Task Prioritization
- Error Identification
- Issue Escalation
Timeline
Healthcare Customer Service Representative (Claims Focused)
Blue Cross Blue Shield
04.2025 - Current
Virtual Customer Service Associate - Healthcare (Claims Operations)
Staffing Solutions
08.2024 - 04.2025
Healthcare Specialist
CareCentrix
05.2018 - 08.2024
High School Diploma -
Wilson High School