Data Analytics Insurance Claims

LORIE SADLER

Address: Gastonia, NC *****

Phone: 704- 460-6062 - Email: **********@*****.***

Professional Summary

Visionary Claims Administration Executive with over 25 years of experience driving operational excellence across medical, dental, vision, and health insurance claims—including 21 years in remote leadership roles. Proven expertise in third-party administration, complex eligibility determinations, and managing large-scale, high-volume claims operations. Skilled in transforming intricate processes into streamlined, compliant, and performance-driven workflows. Adept at leading cross-functional, distributed teams, reducing error rates, and leveraging data analytics to drive policy enhancements and system improvements. Trusted advisor to senior leadership, recognized for mentoring talent, optimizing technology platforms, and consistently delivering measurable gains in accuracy, efficiency, and client satisfaction in fast-paced, highly regulated environments.

Professional Experience

Remote Claims Eligibility Specialist I April 2024 – February 2025

Lincoln Financial - Charlotte, NC

Investigated and assessed insurance claims remotely, verifying documentation accuracy and ensuring adherence to policy guidelines.

Negotiated settlements with claimants, balancing fairness with organizational goals to achieve timely and cost-effective resolutions.

Maintained detailed applicant and claim files, collaborating with external institutions to fact-check and verify documentation.

Assisted applicants by identifying and resolving missing requirements, processing applications, and determining eligibility across multiple programs.

Analyzed claims data trends and generated reports for management, delivering actionable insights to support cross-departmental improvements.

Key Achievements:

Reduced claim processing turnaround times by 20% through proactive documentation audits and early issue detection.

Achieved 99% accuracy rate in eligibility determinations, contributing to department-wide quality recognition.

Played a key role in implementing a trend-reporting system that identified recurring claim discrepancies, resulting in a 15% reduction in claim rework.

Recognized by management for exceptional collaboration across departments, improving cross-functional communication and case resolution speed.

Contributed to training initiatives for new eligibility specialists, improving onboarding efficiency and reducing common processing errors by 12%.

Remote Senior Claims Administrator (Tier 3) April 1999 – March 2024

Key Benefit Administrators - Fort Mill, SC

Review and process Self-Funded and Fully Insured medical, dental, and vision claims in a remote setting, ensuring compliance with plan provisions and state regulations.

Determine eligibility and covered benefits for complex and high-dollar claims, applying detailed knowledge of plan design and regulatory requirements.

Identify system inefficiencies and collaborate with IT and operations teams to implement enhancements that improve claims processing accuracy and turnaround time.

Serve as interim team lead and management backup, overseeing daily remote operations, supporting issue resolution, and mentoring junior staff.

Consistently meet or exceed monthly quality, accuracy, and production goals while managing high-volume claim workloads independently in a remote environment.

Key Achievements:

Reduced claims processing errors by 15% through process refinement and system feedback implementation

Selected to lead cross-functional initiatives to align claims processing with evolving federal and state compliance standards

Awarded Employee of the Quarter three times for exceptional accuracy and leadership contribution

Developed training materials for Tier 1 and Tier 2 claims administrators, improving team accuracy and onboarding efficiency by 25%

Spearheaded a project to identify and correct recurring claim system issues, reducing claim rework rates by 18%

Benefit Analyst April 1997 – April 1999

John Alden - Charlotte, NC

Processed a daily volume of 100+ medical claims with a 98% accuracy rate, specializing in complex and escalated cases

Conducted in-depth work status investigations to verify eligibility and mitigate claim fraud

Collaborated with Customer Service to reduce call hold times by providing front-line support and rapid claims resolution

Assisted leadership in resolving high-profile claims and developing solutions for frequently recurring issues

Key Achievements:

Recognized as Top Claims Processor in 1998 for speed and accuracy

Reduced average processing time per claim by 20% through process streamlining and documentation improvements

Played a key role in redesigning the claims documentation process, contributing to a 10% reduction in customer complaints

Trained and mentored new analysts, accelerating ramp-up time for new hires and improving overall department performance

Education

Bachelor of Arts : Business Administration

Winston-Salem State University - NC

Skills

Advanced Claims Adjudication & Processing

Strong Medical Terminology Knowledge

Health Insurance Benefits Expertise

(Medical, Dental, Vision)

Process Optimization System Troubleshooting

Data Entry Financial Accuracy

Regulatory Compliance (HIPAA, State & Federal)

Claims Investigation Eligibility Verification

Customer Service Conflict Resolution

Process Improvement Workflow Optimization

Complex Problem Case Resolution

Claims Workflow Automation Claims Escalation

SLA (Service Level Agreement) Management

Root Cause Analysis Strategic Decision-Making

Claims Quality Assurance Claims Compliance

Proficiency in Claims Management Software

Claims Data Analytics Documentation Control

Claims Policy Development Change Management

Claims Auditing Training & Development

Cross-Functional Collaboration

Professional Mission Statement

"Dedicated to transforming complex claims operations into models of precision, compliance, and operational excellence. Focused on driving process innovation, optimizing systems, and empowering teams to deliver flawless execution in fast-paced, high-stakes environments. Committed to building trust through accuracy, elevating service standards, and aligning business strategy with measurable outcomes that redefine performance benchmarks across the industry.”

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