Claims Analyst

Terrie Chapman

**** * ***** ****. *** *

Long Beach, CA 90803

P:562-***-**** E: *****************@*******.***

Objective:

Analytical thinker and cross-functional team builder with the keen ability to “think outside the box”, and solve complex business problems with a positive attitude.

Highlights of Skills, Knowledge and Expertise:

Team leader PAS ICD 10 Coding CMS Medical Terminology Commercial, Medicare & Managed Care Impact Nice NGS PAS ECAAAS400 MAESTRO Microsoft Office Advanced UOM Certified HIPPA Compliant M&R Certified self-motivated M&R Certified Detail-oriented Works well under pressureQuick Learner

Employment History:

United Health Care Appeals and Grievance

Claims Business Process Analyst

Subject Matter Expert/Lead October 19, 2015 – Present

I promoted in November 2016 from Appeals Rep Sr. to my current position as a Claims Business Process Analyst for A&G/M&R Part D and Part B Appeals team. With primary responsibilities working cases (appeals, grievances, CD), Daily controls, Monitoring inventory on Expedited, Standard, Coverage Determination, and Grievance cases. Handling escalated or complex issues, conducting root case analysis on compliance issues. Identifying opportunities for improvement and prevention, staying current on CMS Chapter 18 and managed care guidelines. Facilitating monthly meetings to review past performance trends, creating action plans, and procedures to meet goals. Maintain effective communication with management and with vast variety of business partners including, Clinical team, OptumRX and offshore. I would Recruit, interview, directly train and coaching for my team of 13 with my supervisor. I have assisted with focus groups, discovering process gaps and providing feedback in implementing new processes. Through both positions, I have also maintained 100% personal compliance.

Taco Bell Corporation

Service Desk Analyst December 16, 2014-2015

I provided technical assistance and support for incoming queries and issues related to computer systems, software, and hardware. Resolve technical problems with Local Area Networks (LAN), Wide Area Networks (WAN), and other systems.Provided first line analysis and resolution of escalated problems - To include using basic system operating commands to resolve software application problems as well as Hardware problems. Use of Remedy to enter call detail for tracking purpose and to assign ticket to correct TACO to ensure proper provisioning of restaurant systems, regenerate data and reports when needed.Monitor the problem queue and help resolve outstanding issues (conducting outbound calling as appropriate).Manage and prioritize work activities with minimal supervision to meet continuous deadlines which directly impact field operations.

EDUCATION:

Lafayette Technical College-CompTia

Irvine Valley College-Irvine, CA-Pursuing Degree

A.B. Miller High School- Fontana, California- High School Diploma -Class of 2000

Personal and Professional references available upon request

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