Customer Service Manager
Resume:
KEY SKILLS
Soft Skills Hard Skills
Adaptability Microsoft Word & Excel
Work Ethic Medical/Industry Terminology:
Time, priority optimization ICD-9, 10 / CPT Codes, Epic, &
Affable FORTIS
Collaborative ImageNow
HIPAA
SharePoint, Emerge STS, LTD claims management
PROFESSIONAL EXPERIENCE
Inova Health
March, 2017 – Present
Claims analyst III
Collaborate with an amazing team in setting the pace for revenue cycle improvement. Campaign translated to 20% backlog decrease & 14 % increase in realization of goals.
Medical claims, major medical insurance plans, Medicare, Tricare Medicaid. Appeals/grievances. Observe, develop, deploy relative to trends. Team building
Work for and on behalf of stakeholders for timely accurate claims processing. Overpayments, adjustments, follow-up, perform write off prudently
Selman and Co.
May, 2004 – Dec. 2016
Lead Claims Analyst
Anchored team, coached, trained, recognized trends, & adjusted accordingly. Utilized best practices in achieving optimal production and quality, for medical claims resolution. Fostered changes. Resolved escalated cases and grievances. Excellent customer service
Project management assigning in-house claims & to outsourcing agents. Audited, overpayment adjustments & recovery
Worked with Claims Manager to complete new training manual and tested new claims systems with feedback and input
Worked closely with Claims Manager to design, implement & augment strategies to overcome surges, lapses. Any duty as necessary to advance company initiatives
Effective in helping to seamlessly close out operations at Rockville location
ADDITIONAL PROFESSIONAL EXPERIENCE
Broadspire Insurance - Disability Claims Manager
John Hancock Insurance – New Business Administrator
MetLife- Major Medical Claims
EDUCATION
HBX CORe – Harvard Business non-degree courses in Data Analytics, Financial Accounting, & Economics for Managers
College coursework – Univ. of the W.I. (Communications); Ulster County Community College (Business)
Keiser College – Certified Claims Adjuster
PROFESSIONAL DEVELOPMENT
Training, seminars relevant to Insurance Claims
HIPAA
Customer Service
LOMA
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