Claims Examiner Ulysses
Resume:
Tajuana Tillman
Jacksonville, FL 32210
*************@*****.***
Objective To obtain a role where my leadership skills, knowledge, initiative, and combined with experience, can be utilized to better service our internal and external customers.
Education, Colorado Technical University 2015-2019, Bachelor’s Degree
Training & Florida State College at Jacksonville 2013-2014
Certifications Lean Awareness 2013
Lean Problem Solving 2013
Ulysses Coaching Mentor 2011
Qualifications Excellent oral and written communication skills
Knowledge of HIPAA and HEDIS guidelines
Strong follow-up skills
Facilitation and organizational skills
Computer & Client Letter Maintenance PowerPoint
Technical Skills Diamond Excel
Microsoft Word Outlook
Quest Convergence
Work Experience 2001-2021 Florida Blue
2014-Present: Claims Examiner – FEP Operations. Claim
Examine, interpret, and key claims into company’s claims processing systems
Recover overpayment identified through research and claims review
Perform research, request additional information from the provider, member and/or supporting plans and make decisions to return, pend, pay or deny low risk claims in order to property adjudicate claims.
Support continuous improvement efforts by identifying and communicating issues related to claims processing manual and guidelines, etc. and participate in work groups to resolve issues and improve processes.
Coordinate benefits with Medicare and other primary insurance carriers.
2003-2014: Senior Advisor – FEP Operation, Contact
Provided technical guidance by responding to question, assisting with inquires to internal and external business partners.
Direct oversight of staff performing tasks and activities that will impact effectiveness.
Support the commitment of continuous improvement through early identification, investigations, and resolution problems by communicating and coordinating with the appropriate contact.
Reinforce workflow policies and procedures by providing coaching and feedback.
Lead several team meetings and TWC’s.
Foster an environment of teamwork and cooperation focused on providing excellent consumer support services.
Performing necessary research and effectively making decisions to timely and properly resolve customer inquiries with contract benefit guidelines.
Communicated changes in procedures and new guidelines to internal and external business partners
Effectively utilize established controls to monitor inventories via report and spreadsheets.
Contact this candidate