Andrea Dawn Browning
Springfield,TN
Summary
Proficient and caring nursing team member offering outstanding patient-facing experience. Adept at addressing patient needs with compassionate care and attention to detail. Diligent about maximizing satisfaction, safety and wellness while serving patients of all backgrounds.
Overview
11
11
years of professional experience
Work History
Claim Senior Representative
Cigna Healthcare Insurance
12.2012 - Current
- Analyzed and addressed escalated claims to resolve issues quickly.
- 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.
- Developed in-depth understanding of insurance policies and procedures to give accurate recommendations to suit clients' needs.
- Negotiated claim settlements with claimants and compliance to resolve claims efficiently and fairly.
- Updated field operations staff on status of open claims and current actions.
- Collaborated with legal department on important claims.
- 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.
- Followed up with customers on unresolved issues.
- Prepared and presented detailed reports to management on claims issues to aid in decision making.
- Monitored and managed claim expenses to control costs and maximize profitability.
- Maintained confidentiality of patient finances, records, and health statuses.
- Checked documentation for accuracy and validity on updated systems.
- Calculated adjustments, premiums and refunds.
- Resubmitted claims after editing or denial to achieve financial targets and reduce outstanding debt.
- Posted payments to accounts and maintained records.
Education
No Degree - LPN
South College
Nashville, TN09.2023
Skills
- Customer Satisfaction
- Reserve Planning Knowledge
- Data Communications
- Office Supplies and Inventory
- Software Applications
- Personal Data Evaluation
- Cancellation Notifications
- Past Due Balance Management
- Problem Resolution
- Team Goals
- Client Rapport-Building
- Insurance Claim Processing Software
- High-Exposure Claims
- Patient Medical Histories
- Data Quality
- HIPAA Regulations
- Office Operations
- Constructive Feedback
- Vendor Management
- Professional Development
- Service Quality
- Form Preparation
- Regulatory Compliance Adherence
- Payment and Investigation Escalations
- Insurance Terminology
- Claim Validity Determination
- Claims Inspections
- 10-Key Touch
- Complex Problem-Solving
- Prior Authorization Processing
- Complex Negotiations
- Billing Codes
- Legal Guidelines Knowledge
- Microsoft Office
- New Product Information
- Insurance Settlement Negotiation
- Excellent Administrative Abilities
- Policy Knowledge
- Health Insurance Industry Knowledge
- Customer Experience
- Secure Data Practices
- Efficient Service
- Bodily Injury Settlements Proficiency
- Information Updates
- Customer Relationship Management
- Settlement Agreements
- Payment Method
- Team Meetings
- Claims Evaluations
- Service Accounts
- Insurance Policy Coverage Knowledge
- Quality Assurance Evaluation
Timeline
Claim Senior Representative
Cigna Healthcare Insurance
12.2012 - Current
No Degree - LPN
South College
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