Mental Health Insurance Claims
Resume:
GR
GLORIA ROGERS
Professional Summary
Experienced and detail-oriented Claims Adjudicator with 15 years of proven success in validating, analyzing, and processing insurance claims. Skilled in data acquisition, regulatory compliance, and claims negotiation, with a strong track record of supporting accurate resolutions and minimizing risk. Adept at navigating policy guidelines and streamlining documentation workflows to improve efficiency. Committed to contributing immediate value through analytical precision and a deep understanding of the insurance industry.
Work History
Magellan Healthcare - Mental Health Claim Processor Remote
10/2024 - Current
Evolent Health - Claims Adjudicator and Appeals Specialist Chicago, IL
11/2017 - 05/2024
Supported team members in their tasks, contributing to overall team success.
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Increased productivity by effectively managing workload and prioritizing tasks.
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Maintained accurate records and ensured timely completion of all necessary paperwork.
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Enhanced team collaboration, sharing best practices for efficient processing techniques.
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● Processed Medicare and Medicaid claims.
Processed Medical, Dental, Vision, Medicare, Medicaid, and subrogation claims accurately and efficiently, ensuring compliance with policy and regulatory standards.
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Analyzed medical records, billing codes, and documentation to determine eligibility and resolve discrepancies in collaboration with providers and policyholders.
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Maintained thorough documentation while upholding HIPAA compliance and delivering excellent customer service to address claim- related inquiries.
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************@*******.***
University Park, IL 60484
Skills
● HIPAA compliance
● Claims analysis
● Claims processing
● Policy interpretation
● Decision-making skills
● Team collaboration
Education
12/1995
Olive Harvey College
Chicago, IL
Associate of Science: Business
Administration
Completed an Associate Degree in
Business Administration with a focus on
foundational business practices,
accounting, and organizational leadership.
Gained knowledge in economics,
marketing, and management principles.
Demonstrated academic excellence,
consistently appearing on the Dean's List
and Honor Roll.
Valence Health - Claims Adjudicator II
Chicago, IL
09/2015 - 11/2017
Accent Recovery - Claims Auditor
Tinley Park, IL
02/2013 - 09/2015
Consistently met productivity targets and supported team success by mentoring new hires and contributing to process improvement initiatives.
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Investigated and processed Medical, Dental, and Vision insurance claims, verifying coverage and determining fair settlement amounts for multiple clients.
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Collaborated with team members and management to meet departmental goals and service level agreements.
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Assessed claim validity, determined status, and negotiated settlements or issued denials in accordance with policy guidelines.
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Supported Post Team duties and contributed to workflow efficiency across various stages of claims processing.
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Prioritized daily tasks to meet department turnaround goals and ensure timely claim resolution.
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Reviewed insurance claims and member eligibility to identify overpayment trends and compliance issues.
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Audited provider claims for overpayments, ensuring accuracy and adherence to policy guidelines.
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Consistently met or exceeded departmental goals for overpayment recovery and issue resolution.
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Additional Information
Also worked for Cigna Healthcare,United Healthcare, Unicare Healthcare in various roles
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