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Skills

  • Documentation abilities
  • Operational improvement
  • Insurance claims lifecycle management
  • Detail-oriented auditing
  • Reporting skills
  • Mentoring New Employees
  • Team collaboration
  • Project organization
  • Data analysis and reporting
  • Claims Processing

Work Experiences

  • Achieved quota targets over two years.
  • Oversaw the delivery of metric project by system team, which resulted in method.
  • Actively participated in 16-person committees.
  • Collaborated closely with team members to revise complex claim adjudication policies, leading to a 80% increase in first-time claims approval rate.
  • Achieved improvements in 2024.
  • Adjudicated high-dollar claims consistently.
  • Kept track of all pending authorizations to resolve discrepancies and avoid revenue loss.
  • Assisted in building new claim submission guidelines.
  • Applied expertise in policy interpretation.
  • Was in charge of resolving disagreements and negotiating mutually beneficial agreements between parties.

Summaries

  • Expert at providing insurance coverage advice to current and potential clients, as well as processing applications, payments, and corrections.
  • Accomplished Claims Benefit Specialist.
  • Adhered to federal and state regulations.
  • Hardworking Claims Benefit Specialist with 6 years of telecommuting experience meeting customer needs.
  • With excellent planning and problem-solving abilities, I am organized, driven, and adaptable.
  • Analytical Claims Benefit Specialist.
  • Claims Benefit Specialist is a multi-talented Claims Benefit Specialist who is consistently rewarded for planning and operational improvements.
  • Working with stressed, confused, and upset people who need benefits information and supportive guidance to navigate framework systems is one of my specialties.
  • Adept Claims Benefit Specialist.
  • Adept Claims Benefit Specialist with a strong focus on customer service, handling high volumes of disputes while maintaining adherence to company policies and protocols.

Accomplishments

  • Reduced claim payment discrepancies by 9 through diligent review and negotiation with external administrators.
  • Implemented vendor performance tracking, leading to stronger accountability and a 57% improvement in service quality.
  • Reduced interdepartmental communication delays by introducing standardized reporting templates, enhancing workflow efficiency by 6 months.
  • Collaborated with a cross-functional team of 11 departments to resolve escalated claims, improving client satisfaction by 63%.
  • Formulated and executed a claims audit procedure, identifying and rectifying discrepancies that led to a 10 financial recovery.
  • Used Microsoft Excel to develop inventory tracking spreadsheets.
  • Developed a streamlined claims processing workflow that reduced handling time by 45% and improved accuracy across the team.
  • Led a project to integrate Jira into the claims management system, enhancing reporting capabilities and improving decision-making by 19%.
  • Proposed and implemented a continuous improvement initiative that reduced claim rejection rates by 70% within several months.
  • Successfully balanced competing priorities by resolving 6 complex claims while supporting team objectives, resulting in a 63% productivity lift.

Affiliations

  • National Insurance Crime Bureau (NICB)
  • Health Care Compliance Association (HCCA)
  • Society of Human Resource Management
  • Member of the Claims Management Association
  • Toastmasters
  • Member of Professional Liability Underwriting Society (PLUS)
  • International Claim Association (ICA)
  • Mastery in claims auditing through completion of comprehensive Audit Training Program
  • National Association of Subrogation Professionals (NASP)
  • Continuous contributor for Claims Adjudication working group with Lakeside Partners

Certifications

  • Certified in Healthcare Compliance (CHC)
  • Microsoft Certified Systems Engineer (MCSE)
  • Certified Business Analysis Professional (CBAP)
  • Licensed Insurance Adjuster (State Specific)
  • CompTIA Security+
  • Financial Risk Manager (FRM) - Harbor & Co.
  • Chartered Insurance Professional (CIP)
  • Certified Customer Service Manager (CCSM)
  • Fellow, Life Management Institute (FLMI)
  • Certified Healthcare Access Manager (CHAM)

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