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Skills

  • Vendor relationship management
  • Process improvement
  • Compliance with healthcare laws and standards
  • Team collaboration
  • Claims Appeal Resolution
  • Insurance claims lifecycle management
  • Team management
  • Documentation abilities
  • Mentoring New Employees
  • First-time claims approval optimization

Work Experiences

  • Had an excellent attendance record and was always on time for work.
  • Achieved a 51% uplift in productivity across the team.
  • Assisted claimants in navigating complex forms and paperwork, resulting in a 24% spike in properly completed and eligible submissions.
  • Processed 12 invoices and mailed documentation to clients each three years.
  • Analyzed benefit eligibility data for special cases.
  • Adjudicated high-dollar claims consistently.
  • Achieved a 31% boost in claim processing speed.
  • Awarded Excellence Award for exemplary performance.
  • Addressed discrepancies in payment calculations.
  • Oversaw the delivery of metric project by system team, which resulted in method.

Summaries

  • With excellent planning and problem-solving abilities, I am organized, driven, and adaptable.
  • Recognized on a regular basis for outstanding performance and contributions to the Miscellaneous industry's success.
  • Achieved cost savings of $8 annually.
  • Strengths in project management and process improvement backed up by Miscellaneous training.
  • Advocated on behalf of clients in standard cases.
  • 14 years of experience in healthcare compliance.
  • Accomplished Claims Benefit Specialist recognized for advocating on behalf of clients in method cases, producing a 52% improvement in dispute resolution outcomes.
  • Offering 4 years of experience as well as the willingness to take on any challenge.
  • Accomplished Claims Benefit Specialist.
  • Achieved a 85% improvement in timely claim settlements.

Accomplishments

  • Maintained a 71% error-free score in claim approvals and denials by conducting regular internal audits and quality checks.
  • Collaborated with team of 3 in the development of metric.
  • Documented and resolved process which led to initiative.
  • Successfully balanced competing priorities by resolving 6 complex claims while supporting team objectives, resulting in a 63% productivity lift.
  • Collaborated with software developers to upgrade the claims management system, resulting in a 49% improvement in user efficiency.
  • Reconciled inconsistencies across 17 vendor accounts, recovering over 7 in misapplied benefits by conducting thorough audits.
  • Trained 9 junior claims specialists in regulatory compliance policies, contributing to a 39% reduction in processing errors.
  • 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.
  • Maintained an average customer satisfaction score of 77% by resolving escalated claims disputes in a professional and timely manner.

Affiliations

  • Medical Group Management Association (MGMA)
  • Member of the Claims Management Association
  • Member of Professional Liability Underwriting Society (PLUS)
  • Toastmasters
  • Mastery in claims auditing through completion of comprehensive Audit Training Program
  • American Bar Association – Involvement with insurance litigation task force meetings
  • Continuous contributor for Claims Adjudication working group with Lakeside Partners
  • National Certified Investigator & Inspector Training (NCIT) alumni
  • Project Management Institute
  • International Claim Association (ICA)

Certifications

  • Certified Fraud Examiner (CFE)
  • CompTIA A+ Technician
  • Certified in Healthcare Compliance (CHC)
  • Certified Business Analysis Professional (CBAP)
  • Certified Professional in Healthcare Quality (CPHQ)
  • Fellow, Life Management Institute (FLMI)
  • Professional, Academy for Healthcare Management (PAHM)
  • Certified Health Insurance Specialist (CHS)
  • Certified Healthcare Access Manager (CHAM)
  • Certified Claims Professional (CCP)

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