Alta Baker
Greensboro,North Carolina
Summary
With a proven track record at UnitedHealth Group, I excel in de-escalation techniques and analytical skills, enhancing customer satisfaction and operational efficiency. My expertise in claims processing and dedication to professional development have consistently exceeded performance targets, showcasing my ability to thrive in fast-paced environments and lead with confidence.
Overview
8
8
years of professional experience
Work History
Resolution Specialist
UnitedHealth Group
09.2020 - Current
- Improved customer satisfaction by resolving complex issues promptly and professionally.
- Managed high volumes of customer inquiries for efficient resolution, enhancing overall client experience.
- Streamlined resolution processes with established guidelines, leading to faster outcomes and better customer satisfaction.
- Collaborated effectively with cross-functional teams to provide comprehensive solutions for clients'' concerns.
- Assisted colleagues in navigating challenging situations by sharing expertise and offering guidance when requested or needed.
- Contributed to a positive team culture by offering support and encouragement to peers, fostering a collaborative and high-performing work environment.
- Leveraged strong listening skills to fully understand the customer''s perspective, enabling tailored and empathetic responses during conflict resolution.
- Prepared written opinions or decisions regarding cases.
- Trained new team members on company policies and resolution techniques, ensuring consistency in service delivery across the team.
- Implemented effective communication skills to deescalate high-tension situations, fostering positive relationships between customers and the company.
- Coordinated with internal departments as needed to gather information on each individual case, facilitating a more accurate and timely response.
- Maintained detailed records of all interactions and resolutions for future reference and analysis purposes, improving overall efficiency in handling similar cases down the road.
- Handled escalated calls calmly and professionally, ensuring that even highly dissatisfied customers felt heard and supported throughout the process.
- Exceeded performance targets consistently by prioritizing workload effectively and managing time efficiently during periods of high call volume or complex caseloads.
- Participated actively in ongoing professional development opportunities to stay current on industry best practices and enhance personal skillset.
- Advised parties on dispute resolution processes, policies and procedures, helping disputants make informed choices.
Claims Representative
UnitedHealth Group
04.2016 - 09.2020
- Enhanced claim processing efficiency by streamlining workflows and implementing best practices.
- Reduced turnaround time for claim settlements by prioritizing tasks and managing deadlines effectively.
- Improved customer satisfaction by providing timely and accurate information on claim status and resolution.
- Collaborated with cross-functional teams to expedite complex claims investigations and resolutions.
- Minimized financial losses by identifying fraudulent claims through thorough analysis and investigation.
- Negotiated favorable settlements with claimants, resulting in cost savings for the company.
- Maintained compliance with industry regulations by adhering to established procedures and guidelines in claims handling.
- Conducted detailed assessments of claims documents, ensuring accuracy and completeness before submission for approval.
- Provided exceptional customer service, addressing concerns and resolving issues promptly to maintain client satisfaction.
- Trained new Claims Representatives on company policies, procedures, and software systems, improving overall team productivity.
- Assisted in updating company-wide claims manual, incorporating new regulatory requirements for more efficient processes.
- Streamlined documentation processes through digitization efforts, reducing paperwork while maintaining data accuracy and security.
- Conducted thorough research on industry trends, enabling proactive adjustments to internal processes as needed for improved performance.
- Worked productively in fast-moving work environment to process large volumes of claims.
- Researched and analyzed complex claims to determine next steps and possible outcomes.
- Updated claims system to track claim status and provide relevant information to other department.
- Followed up with customers on unresolved issues.
- Collaborated with internal departments and external vendors to achieve fast resolution of claims.
- Maintained accurate and up-to-date records of claim information for future reference.
- Examined reports, accounts, and evidence to determine integrity and accuracy of information.
- Monitored and managed claim expenses to control costs and maximize profitability.
- Prepared and presented detailed reports to management on claims issues to aid in decision making.
- Maintained strong knowledge of basic medical terminology to better understand services and procedures.
- Generated, posted and attached information to claim files.
- Carried out administrative tasks by communicating with clients, distributing mail, and scanning documents.
- Prepared insurance claim forms or related documents and reviewed for completeness.
- Maintained confidentiality of patient finances, records, and health statuses.
- Checked documentation for accuracy and validity on updated systems.
- Calculated adjustments, premiums and refunds.
- Posted payments to accounts and maintained records.
- Made contact with insurance carriers to discuss policies and individual patient benefits.
- Notified insurance agents and accounting departments of policy cancellations and changes.
Education
High School Diploma -
Ben L. Smith High School
Greensboro, NC08.2015
Skills
- De-Escalation Techniques
- Assertiveness
- Analytical Skills
- Negotiation Management
- Task Prioritization
- Professionalism
- Time management abilities
- Effective Communication
- Problem-solving aptitude
- Decision-Making
- Multitasking
- Self Motivation
- Team Collaboration
- Attention to Detail
- Reliability
- Document Preparation
- Goal Setting
- Active Listening
- Insurance Claims Review
- Flexible Schedule
- Time Management
- Documentation Review
- Coverage Determination
- Data Entry
- Customer Service
- Insurance Claim Forms Review
- Eligibility Determination
- Account Management
- Understanding of medical terms
- Critical Thinking
- Denied claims identification
- Payment and Investigation Escalations
- Excellent administrative abilities
- Claims Processing
- Patient Rapport
- Billing Software
Timeline
Resolution Specialist
UnitedHealth Group
09.2020 - Current
Claims Representative
UnitedHealth Group
04.2016 - 09.2020
High School Diploma -
Ben L. Smith High School