Alana Chevrette
Summerville,SC
Summary
As an experienced Claims Adjuster, I possess a wealth of experience in managing medical and dental claims and reaching accurate liability determinations through detailed reviews. My expertise lies in addressing complex claims with problem-solving and analytical skills, coupled with an ongoing understanding of the evolving medical services and procedures. As a proficient claims processor, I am driven to make precise decisions on claims, scrutinizing each with due diligence, informed by my extensive knowledge and outstanding analytical capabilities. My experience spans both straightforward and intricate claims, and I am eager to contribute in a dynamic, fast-paced work setting.
Overview
21
21
years of professional experience
Work History
Claims Adjuster III
Anthem Blue Cross and Blue Shield
Manchester, NH
05.2003 - 01.2022
- Guided claim procedures and addressed both minor and major concerns throughout the claims-handling process.
- Processed claims in accordance with client and corporate policies, procedures, and best practices, ensuring compliance with statutory, regulatory, and ethical standards.
- Demonstrated sound judgment and decision-making skills in analyzing claims exposure, determining the appropriate course of action, and settling claims effectively.
- Possess expert-level knowledge in health insurance regulations, policies, procedures, and best practices.
- Documented and communicated claims activities in MCW, Blue2, and Aces.
- Performed data entry tasks, including claim file updates and forms.
- Interpreted policy language to determine coverage for insureds under various lines of business.
- Examined claims that were investigated by insurance adjusters, further investigating the questionable claims to determine whether to authorize payments.
- Paid and processed claims within designated authority level.
- Reported overpayments, underpayments, and other irregularities.
- Processed claim payments, reserves, and new claims into the computer system, ensuring concise and adequate file documentation.
- Provided training sessions for new adjusters on best practices for adjusting claims.
Pharmacy Technician
Rite Aid
Hooksett, NH
06.2001 - 05.2003
- Handled prescription orders at counter and in drive-thru line
- Processed insurance for prescriptions received
- Stocked supplies and set up cash drawers to maintain readiness for day's business
- Called insurance companies to retrieve patient information to determine final cost of prescription
- Minimized risk and maintained accuracy, adhering to proper medication-handling techniques and industry best practices
- Obtained timely payments from customers and insurance companies
- Met customer needs with fast and knowledgeable pharmacy support
- Managed records with high accuracy, including inputting new orders and documenting payments.
Education
High School Diploma -
Concord Christian School
Concord, NH06.2001
Skills
- Claims processing
- Claims corrections and adjustments
- Regulatory compliance
- Time Management
- Problem assessments
- Quality control
- Claims investigation
- Customer experience control
- Best practices implementation
- Record preparation
- Medical Records review
- Insurance Coverage Determination
- Medical Coding
- Quality Control
- Data Entry
- Customer Service
- Dispute Resolution
- Paperwork Processing
Timeline
Claims Adjuster III
Anthem Blue Cross and Blue Shield
05.2003 - 01.2022
Pharmacy Technician
Rite Aid
06.2001 - 05.2003
High School Diploma -
Concord Christian School
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