Summary
Overview
Work History
Education
Skills
Timeline
Generic

Andrea Johnson

Senior Claim Specialist
Garland,TX

Summary

Results-driven claims processing specialist with proven expertise in conflict resolution and team leadership. Recognized for enhancing workflow efficiency and mentoring junior staff, contributing to organizational growth and customer satisfaction.

Overview

12
12
years of professional experience

Work History

Senior Claim Processing Specialist/ Case Manager

AETNA
Dallas, TX
02.2025 - Current
  • Processed complex insurance claims, ensuring compliance with company policies and regulatory standards.
  • Reviewed and analyzed claim documentation for accuracy, identifying discrepancies and recommending resolutions.
  • Evaluated claim submissions for accuracy, identifying discrepancies and recommending necessary adjustments.
  • Collaborated with cross-functional teams to resolve claim disputes and enhance customer satisfaction.
  • Reviewed applications and supporting documents to verify claims eligibility and accuracy.
  • Utilized claims management software to track progress, streamline workflows, and improve data accuracy.
  • Assured timely verification of insurance benefits prior to patient procedures or appointments.

Lead Claims Processor

United Healthcare
Dallas, TX
03.2014 - 01.2025
  • Led claims processing team to ensure timely and accurate claim resolutions.
  • Managed high-volume caseloads while maintaining exceptional quality standards, contributing to overall departmental success.
  • Enhanced workflow efficiency by implementing standardized procedures and best practices.
  • Mentored junior staff on complex claims issues and industry regulations.
  • Analyzed claims data to identify trends and recommend process improvements.
  • Assured timely verification of insurance benefits prior to patient procedures or appointments.
  • Prepared insurance claim forms or related documents and reviewed for completeness.

Education

High School Diploma -

Penn Foster College
Scottsdale, AZ

Skills

Claims management

Claims software

Claims review

Team leadership

Claims processing software

Timeline

Senior Claim Processing Specialist/ Case Manager

AETNA
02.2025 - Current

Lead Claims Processor

United Healthcare
03.2014 - 01.2025

High School Diploma -

Penn Foster College

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Andrea JohnsonSenior Claim Specialist