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Skills

  • Operational improvement
  • Claims accuracy auditing
  • Team building
  • Dispute resolution
  • Customer satisfaction improvement
  • Time management
  • Case file organization
  • Claims backlog reduction
  • Organization
  • Detail-Oriented Documentation

Work Experiences

  • Analyzed historical claims data across QuickBooks and provided actionable insights, leading to a reduction in claim rejection rates.
  • Boosted team efficiency.
  • Collaborated with external departments.
  • Kept track of all pending authorizations to resolve discrepancies and avoid revenue loss.
  • Collaborated with third-party administrators to audit claims accuracy, resolving discrepancies and recovering $14 within three years.
  • Completed project within 6 months.
  • Assisted in executing solutions for high-priority claims.
  • Adhered to regulatory compliance standards for metric.
  • Had an excellent attendance record and was always on time for work.
  • Collaborated with third-party administrators.

Summaries

  • Proven leadership, operational excellence, and organizational development skills, as well as a thorough understanding of the framework business.
  • Adept at ensuring claims meet regulatory standards.
  • Effective at managing phone calls, emails, letters, and in-person requests for assistance while adhering to initiative regulations and process department guidelines.
  • Recognized for motivating management team members to achieve their goals and fostering innovative work environments.
  • Addressed discrepancies with third-party administrators.
  • Dedicated to learning, growing, and succeeding in Miscellaneous.
  • Strengths in vendor management and workflow optimization backed up by Miscellaneous training.
  • Collaborative Claims Task Assistant with deep experience in regulatory compliance and process optimization. Known for reducing error rates by 22% and working well across multiple departments to improve outcomes.
  • Experienced method Insurance Specialist with a track record of managing large caseloads in high-pressure situations.
  • Achieved a 17% reduction in errors.

Accomplishments

  • Collaborated with sales to develop and implement a claims prioritization system, reducing turnaround time by 56%.
  • Developed and maintained tracking mechanisms that improved long-term claims resolution timelines, driving a 15% efficiency increase.
  • Analyzed key performance metrics and provided actionable insights that helped reduce overall processing errors by 50%, improving company KPIs.
  • Created training materials for 3 new staff members, ensuring quicker onboarding and reducing claims audit errors by 81%.
  • Documented and resolved framework which led to standard.
  • Used Microsoft Excel to develop inventory tracking spreadsheets.
  • Performed in-depth analysis on previously denied claims, identifying root causes that allowed the team to reduce rejections by 32%.
  • Led a project that enabled a smoother claims adjustment process, reducing the overall time to resolve claims by 6 days.
  • Worked closely with metric to establish a more efficient claim intake process, resulting in a 24% increase in throughput.
  • Reduced backlog of open claims by 18% by prioritizing high-risk claims and streamlining the review process.

Affiliations

  • National Healthcare Anti-Fraud Association (NHCAA)
  • International Association of Administrative Professionals
  • International Foundation of Employee Benefit Plans (IFEBP)
  • Insurance Data Management Association (IDMA)
  • Public Risk Management Association (PRIMA)
  • American Institute For Chartered Property Casualty Underwriters (AICPCU)
  • American Medical Informatics Association
  • Certified Professional in Healthcare Risk Management (CPHRM)
  • Toastmasters
  • Claims Law Associate Certification (CLAC) – American Educational Institute

Certifications

  • Microsoft Certified Systems Engineer (MCSE)
  • Licensed General Lines Insurance Adjuster - Arizona
  • First Aid/CPR Certified
  • Lean Six Sigma Green Belt (LSSGB) – Beacon Labs
  • Certified Casualty Adjuster (CCA) – Meridian
  • Salesforce
  • Certified Public Accountant
  • Health Insurance Associate (HIA) - Ironclad Systems
  • Certified Fraud Examiner (CFE) - Beacon Labs
  • Workers' Compensation Professional (WCP) - Lakeside Partners

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