Claims Analyst Compliance
Resume:
Kristen Frye
Prosper, Texas
*5078
Email: ***********@****.***
Highlights of Qualifications
Excellent communication and strong customer skills
Proven strong work ethic with high level of professionalism
A team player with a proven ability to handle multiple projects simultaneously in a fast- paced environment.
Proficient word processing and file maintenance skills
Effective organizational, communication, and interpersonal skills
Ability to use personal computer and software to develop spreadsheets, databases, and do word processing
Employment History
Senior Compliance Specialist
Scout & Cellar
Farmers Branch, Texas
April 2019 – Present
Manages registrations, licensing and contractual obligations both State wide and Federally.
Assists and maintains the implementation of the company compliance strategy while identifying areas
Audits and reconciles state sales taxes in accordance with State laws and statutes, ensuring timely filing and meeting all deadlines.
Collaborates with supply chain and product teams to ensure all compliance standards are met in regards to products, sales, volume limits and state availability.
Knowledgable with TTB requirements in regards to label COLA registrations.
Brand Standard and Compensation Specialist
Scout & Cellar
Farmers Branch, TX
June 2018- April 2019
Interpreted reports and performs statistical analysis and interpretation to provide solutions and recommendations on compensation practices and projects.
Analyzed, audited and identified trends in compensation payouts, consultant activity, fast start activity and presented to key stakeholders.
Recognizes and identifies potential areas where existing policies, standards and procedures require change.
Ensures compliance of contractual and licensing obligations federally and state wide, while ensuring timely processing on all contractual paperwork.
Audited and enforced all processes and procedures required of the field as stated in the Company Policies and Procedures; geneology, enrollment requirement, termination process and FDA requirements when marketing the products.
Collected and analyzed all data from the first year of field commission payouts to compile the Companys first ever Income Disclosure.
Compliance Analyst
Project and Vendor Management Advisors, LLC
Prosper, Texas
May 2017- July 2018
Collaborated with Texas Department of Agriculture to audit the purchasing and procurement of Texas ISD’s Child Nutrition Program.
Interpret and applied USDA policies and state guidelines/policies to ensure accurate and appropriate measures were implemented and followed.
Worked effectively and co-operatively within a team by participating in meetings, sharing information, analyzing operational processes and needs by providing input into proposed changes and procedures.
Communicated findings with schools within the ISD’s to ensure the ongoing compliance of soliciting and vetting vendors in order to avoid future penalties or fines.
Claims Assessor, Claims Services Branch
Ministry of Health and Long-Term Care
Oshawa, Ontario
September 2019- June 2014
Working effectively in a fast-paced team environment to process incoming claims and process them accordingly to standards and policies.
Reading and interpreting medical reports in order to process medical claims. Able to identify procedures that were covered and not covered by insurance.
Adjudicated and facilitated third party coverage for health care benefits. Ability to use tact and ask relevant questions regarding billing irregularities while protecting patient personal information.
Explain to patient payment policies and procedures on third party health coverage and procedures involved.
Worked effectively and co-operatively within a team by scheduling and participating in meetings, sharing information, analyzing operational processes and needs by providing input into proposed changes and procedures.
Interpreting and applying legislation, policies and providing resolution verbally and/or in writing to ensure accurate and appropriate measures.
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Claims Analyst, Section 8 Division
Ministry of Health and Long-Term Care
Toronto, Ontario
September 2004- September 2009
Demonstrated knowledge of relevant government policies and procedures
Reviewed and researched individual clinical reviews sent in Doctors seeking approval for access to specialized drugs. Based on the clinical criteria and ministry standards, either approved, denied or requested additional information to help expedite and complete the request for coverage.
Responded to Doctor's requests and correspondence in a professional and in a timely manner while placing emphasis on high priorities and urgent situations. Always used discretion in dealing with confidential and sensitive issues.
Performed administrative functions, like validating and coding files. Producing and transmitting statistical information, ensuring physical security of documents, demonstrated organizational, facilitation, problem-solving, analytical and time management skills. Able to meet strict deadlines and collaborate with team members during meeting and workshops
Education
Health Sciences Degree
Seneca College, King City, Ontario September 1996-April 2000
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