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Skills

  • Program equipment
  • Workflow management
  • Process optimization
  • Benefits review
  • Attention to detail
  • Ability to maintain confidentiality
  • Insurance claims software proficiency (ServiceNow)
  • Communications
  • Claims Processing
  • Cost control in claims settlements

Work Experiences

  • Achieved reduction over a 9-week period.
  • Analyzed complex insurance claims.
  • Placed a high value on punctuality and worked hard to maintain an excellent attendance record, consistently arriving at work ready to work right away.
  • Cut cycle times from 3 days to 15 days.
  • Achieved 20% higher performance than department standards.
  • Assisted cross-functional teams in optimizing claims adjudication processes, reducing disputes by 33%.
  • Created claims risk reports.
  • Collaborated with data teams.
  • Created and monitored claims risk reports that identified at-risk accounts, enabling preemptive action and reducing overall payouts.
  • Decreased settlement times.

Summaries

  • Accomplished Claims Processing Specialist with proven ability to lead training sessions, resulting in a 70% reduction in team errors and increased overall efficiency by 53%.
  • Accomplished Claims Processing Specialist.
  • Claims Processing Specialist with strong attention to detail.
  • Achieved a 20% increase over target expectations.
  • Collaborative Claims Specialist with a proven record.
  • Bringing 9 years of experience in the field, as well as superior vendor management and cross-functional collaboration abilities.
  • Recognized on a regular basis for outstanding performance and contributions to the Miscellaneous industry's success.
  • Within Miscellaneous, senior Claims Processing Specialist and outstanding performer in team leadership and performance reporting.
  • Collaborated with IT and operations teams to introduce a new claims software tool, resulting in streamlined processing and a reduction in claim cycle time by 9 days.
  • Costs were consistently reduced while profits were increased.

Accomplishments

  • Used Microsoft Excel to develop inventory tracking spreadsheets.
  • Documented and resolved category which led to standard.
  • Reduced escalated disputes by 75% by efficiently resolving high-priority claims in collaboration with the legal team.
  • Authored training documentation on claims software best practices which reduced new team member onboarding time by 5 weeks.
  • Handled claims escalations and resolved disputes, leading to a 46% increase in customer satisfaction scores.
  • Proactively identified potential breaches in claims compliance, leading to a 82% improvement in audit pass rates.
  • Generated comprehensive reports about claims trends, leading to a 29% decrease in erroneous claims over a 6-month period.
  • Managed high-volume claims processing environment, consistently maintaining 26% or above key performance indicators (KPIs).
  • Utilized root cause analysis to effectively improve claims approval efficiency by 40% in 2017.
  • Trained and mentored junior claims specialists, resulting in a 39% reduction of error rates in claims processing within the team.

Affiliations

  • Engaged with the Medical Claims Processing Certification Board (MCPCB) for ongoing education
  • Joined certification programs by the Insurance Institute of America (IIA) specializing in Claims and Dispute Resolution
  • Trained in claims adjudication as part of completion of Scrum Master under the Institutes CPCU Society
  • Member of International Compliance Association (ICA) for insurance regulatory updates
  • Certified in framework through Council for Affordable Quality Healthcare (CAQH)
  • Project contributor in International Foundation of Employee Benefit Plans (IFEBP) claims management working groups
  • Enrolled in Community Associations Institute (CAI) relevant to risk management processes
  • Volunteer with Insurance Accounting & Systems Association (IASA) claims track programs
  • Membership, National Insurance Crime Bureau (NICB) contributing to knowledge on fraud detection
  • Enrolled in the Healthcare Information and Management Systems Society (HIMSS)

Certifications

  • Medical Billing and Coding Certification (CPC or CBCS) - Northwind
  • Healthcare Anti-Fraud (AHFI) Certification - Vantage
  • Certified Claims Professional (CCP) - Meridian
  • Microsoft Certified Systems Engineer (MCSE)
  • Certified Business Analysis Professional (CBAP)
  • Cisco Certified Internetwork Expert (CCIE)
  • ICD-10 Coding Certification Vantage
  • Apple Certified Associate (ACA)
  • Bilingual Customer Service Certification - Vantage
  • Health Insurance Associate (HIA) – America's Health Insurance Plans (AHIP)

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