Alexys Grossman
Dayton,TN
Summary
Skilled in handling complex insurance claims and policy processing with experience in navigating through various insurance software systems. Demonstrates strong analytical skills, adept at interpreting policies and efficiently resolving claims to the satisfaction of all parties involved. Known for maintaining high accuracy levels in document processing and data entry, contributing to streamlined operations and improved customer service outcomes. Continuously seeks ways to optimize workflows and enhance team productivity, leading to more efficient claim resolution processes.
Overview
4
4
Languages
6
6
years of professional experience
Work History
Insurance Follow Up/Denial Specialist
UPMC
Remote
06.2025 - Current
- Streamlined denial management processes by enhancing communication with internal teams to improve resolution times.
- Reviewed denial claims to identify root causes and trends, informing process improvement initiatives.
- Collaborated with healthcare providers to gather necessary documentation for claims.
- Monitored assigned accounts to optimize payment resolution and identify appeal opportunities.
- Maintained accurate records of denials and appeals within the system.
- Researched payer policies to ensure compliance during appeal processes.
Medical Claims Specialist
Firstsource Solutions
Remote
04.2023 - 05.2025
- Processed medical claims using advanced management software, contributing to timely reimbursement for healthcare providers.
- Reviewed documentation to ensure accuracy and completeness in claims submissions, enhancing claim approval rates.
- Communicated with healthcare providers to resolve discrepancies in claims.
- Audited provider bills for accuracy prior to submission to insurance companies.
- Collaborated with team members to streamline workflows, resulting in reduced processing time for claims.
- Maintained up-to-date knowledge of insurance policies and regulations.
Claims Adjuster
United Healthcare
Murfreesboro, Tennessee
02.2021 - 10.2024
- Coordinated with medical providers to obtain necessary documentation, facilitating timely claims processing.
- Reviewed and analyzed claim submissions for accuracy and completeness.
- Investigated discrepancies in claims to ensure thorough resolution and compliance with regulations.
- Assessed medical records, police reports, and relevant documents during investigations.
- Evaluated insurance claims and prepared recommendations for payment or denial based on coverage and liability assessment.
- Ensured compliance with departmental guidelines and applicable state laws.
Education
Associate of Applied Science - Veterinary Science
Penn Foster Career School
Scranton, PA08-2026
Skills
- Regulatory compliance
- Data analysis
- Analytical detail orientation
- Attention to detail
- Effective communication
- Team collaboration
- Client management
- Customer service excellence
Languages
ASL
Limited
Spanish
Limited
French
Limited
Korean
Limited
Timeline
Insurance Follow Up/Denial Specialist
UPMC
06.2025 - Current
Medical Claims Specialist
Firstsource Solutions
04.2023 - 05.2025
Claims Adjuster
United Healthcare
02.2021 - 10.2024
Associate of Applied Science - Veterinary Science
Penn Foster Career School