Angee Gachelin
Irvington
Summary
Healthcare Fraud & Claims Analyst with 5+ years of experience across insurance, pharmacy, and patient support environments. Proven ability to analyze healthcare claims, identify irregular billing patterns, support fraud, waste, and abuse (FWA) investigations, and ensure regulatory compliance (HIPAA). Experienced in high-volume claims review, escalations, and cross-functional collaboration within payer and PBM systems. Seeking higher-level fraud, compliance, or SIU roles.
Overview
8
8
years of professional experience
1
1
Certification
Work History
Fraud Analyst
Horizon BCBSNJ
08.2025 - Current
- Analyzed and investigated potential fraudulent activities to mitigate financial loss.
- Collaborated with cross-functional teams to enhance fraud detection methodologies.
- Utilized advanced data analytics tools to identify trends and anomalies in claims processing.
- Review and analyze healthcare claims for potential fraud, waste, and abuse (FWA).
- Identify abnormal billing trends, suspicious claim patterns, and high-risk provider or member activity.
- Document investigative findings and escalate cases to appropriate fraud or SIU teams.
- Developed and implemented training programs for junior analysts on fraud prevention techniques.
Call Center Customer Service Representative
Safety First
11.2023 - Current
- Managed incoming calls, assisted customers with locate requests, and resolved inquiries.
- Processed web tickets and responded to web chat requests efficiently.
- Handled escalations and communicated backup messages when necessary.
- Provided product and service information to meet customer needs.
- Performed accurate data entry (35 WPM) and maintained organized records.
Pharmacy Technician
RVL Pharmacy
06.2021 - 03.2023
- Provided customer support with prescription management and insurance verification.
- Managed patient registrations, verified insurance information, and ensured prescription accuracy.
- Coordinated with physicians, insurance providers, and customers to resolve prescription-related issues.
Patient Support Specialist and Medical Billing Representative
IQVIA
07.2018 - 05.2021
- Assisted patients with insurance verifications and registration for healthcare services.
- Handled escalated calls related to insurance claims and copays, ensuring positive outcomes.
- Maintained accurate, confidential patient records, complying with HIPAA standards.
- Developed in-depth knowledge of healthcare products to assist in patient support and insurance queries standards.
- Streamlined payment transactions and reimbursements by integrating with payors' financial systems and claims processing platforms.
Education
No Degree - Healthcare Administration
Kean University
Union, NJHigh School -
Marion P. Thomas
Newark, NJ06.2015
Skills
- Healthcare Fraud, Waste & Abuse (FWA)
- Claims Analysis & Review
- Insurance Policy Interpretation
- HIPAA Compliance
- Risk Identification & Escalation
- Claims Processing & Billing
- Pharmacy & Rx Claims
- Case Documentation
- Data Analysis & Quality Review
- Provider & Member Support
SOFTWARE
- Microsoft Office (Word, Excel, Outlook, PowerPoint)
- CRM Software (Customer Relationship Management)
- Insurance Management Systems
- Data Entry Software
- HIPAA Compliance Software
- Rx claims
Certification
Pharmacy technician
BLS
CPR certification
Timeline
Fraud Analyst
Horizon BCBSNJ
08.2025 - Current
Call Center Customer Service Representative
Safety First
11.2023 - Current
Pharmacy Technician
RVL Pharmacy
06.2021 - 03.2023
Patient Support Specialist and Medical Billing Representative
IQVIA
07.2018 - 05.2021
No Degree - Healthcare Administration
Kean University
High School -
Marion P. Thomas