Experienced Data Entry & Claims Auditor
Resume:
Lisa D. Testa
Dallas, Georgia 30132
Qualifications: Independent, dynamic, results-driven professional equipped with successful Customer interaction skills in both Insurance and Banking settings. Strong leader with highly developed supervisory skills in auditing, banking and insurance settings. Analytical problem solver with strengths in identifying client needs and developing timely and accurate responses to close claims and outstanding issues related to claims. Solid communicator with strong interpersonal and motivational skills.
Relevant Competencies:
Customer Service
Auditing
Quality Control
Personnel Supervision
Claims Processing
Data Entry
Experience:
Group Policy Administrator
NE Delta Dental, Concord, NH and Atlanta, GA 2014-Present
Administration of new group contracts and application of policy data into corporate systems. Liaison between sales and marketing for proper coverage administration of group policies. Maintenance of group coverage as needed, along with internal systems testing and maintenance to ensure proper claims flow/decisioning. Resolution of systemic structural issues related to group claims suspensions and other auditing as needed. Consistently exceeded goals for enablement of new group policy management and administration.
Claims Edit Auditor and Adjudication
NE Delta Dental, Concord, NH 2012-2014
Current management of approximately 80 claims queues for audit management, correction and ultimate payment. Thorough understanding of and currently working under NEDD operating policies. Other responsibilities include processing refund checks associated with overpayment of claims or termed policies. Participation in software test team before rollout of General availability of software. Routinely part of project team to address inter/intra departmental processing issues (Audit the Auditor). Continual operation above required standards relative to claims processed and accuracy of those claims.
Group Auditor
United Healthcare, Hooksett, NH 2006-2012
Responsible for the completion of audit on customer enrollment and claims documentation. Auditing, correction, fraud detection and processing of applications and claims was completed in a timely manner to ensure all documentation was submitted into internal work systems. Remediation of claims to include dialogue with clients and providers to address outstanding issues. Responsible for other areas to include training personnel in the auditing process and work correction processes for the team.
Claims Processor
Cigna Healthcare, Hooksett, NH 1998-2006
Processed provider claims to include audit and data entry of claims. Remediation of claims to include communication to and with providers as well as policyholders. Training team members on data entry work, filing claims and remediation process.
Manager/Lead Teller
Granite Bank, Concord, NH 1989-1998
Management of front-end bank operations to include customer service and staff supervision of 20+ employees. Scheduling of personnel, daily audits of front end, ATM, vaults and drive thru.
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