Angela Baker
Ankeny,IA
Summary
Dynamic professional seeking a position that leverages existing strengths while providing opportunities for skill development and meaningful contributions to organizational success in a collaborative environment. Proven expertise in analyzing and resolving claim disputes efficiently and effectively, complemented by strong negotiation and conflict resolution skills that consistently yield favorable outcomes. A solid track record of exceptional problem-solving abilities, coupled with a commitment to maintaining high standards in claims processing, positions this candidate as a valuable asset to any team.
Overview
22
22
years of professional experience
Work History
Claims Resolution Analyst
Centene
St Louis, MO
08.2020 - 09.2026
- Receive and respond to internal and external claims-related issues.
- Initiate or update provider-related database information.
- Complete claims-related research projects.
- Maintain data integrity in the provider claims processing system.
- Investigate and communicate reimbursement and benefit changes.
- Educate provider relations, provider services, and claims liaisons on policies and procedures for referrals and claims submission.
- Assist providers in resolving claims submission and payment accuracy issues.
- Attend state meetings on fee schedules and benefit changes.
- Assist with provider complaints and resolutions and process claims adjustments.
- Review Medicaid Bulletins for changes and submit change requests (CRs) to update payment systems
Medical Claim Adjustor
Nationwide Insurance
Des Moines, IA
10.2013 - 01.2020
- Assisted internal and external customers with inquiries by phone or written correspondence, ensuring high-quality customer service.
- Trained and developed new employees on claims handling processes and system navigation.
- Recognize recovery opportunities regarding subrogation and salvage.
- Led project teams to ensure successful completion of tasks
- Assist internal and external customers with problems or questions by phone or through written correspondence while providing a high level of customer service.
- Identified potential fraud indicators and collaborated with SIU to address concerns.
- Team leader on projects
Property Claims Adjustor
Nationwide Insurance
Des Moines, IA
10.2012 - 10.2013
- Delivered exemplary customer service to policy holders, agents, and PRN vendors, enhancing satisfaction and trust
- Managed complex claims without supervision
- Negotiate the best resolution between policy holders, contractors and vendors
- Utilized organization skills to manage workload effectively to maintain an adequate work volume
- Effective organization skills to maintain an adequate work volume
Underwrite Assistance/Commercial SR Processor
Nationwide Insurance
Des Moines, IA
01.2005 - 10.2012
- Processed commercial new business, renewals, and amendments with high efficiency and accuracy.
- Underwrite Commercial polices up to authority level of $2,000
- Analyzed best practices and communicated changes to team members to enhance workflow.
- Trained and developed employees through 1:1 mentoring, fostering associate growth and skill enhancement.
- Planned and executed team building events to enhance communication among team members.
Education
Bachelor’s Degree - Organizational Management, Human Resources Management, International Human Resource
Ashford University
Clinton, IA10-2012
Skills
- Clear spoken communication
- Proficient in Microsoft Office
- Claims analysis
- Claims evaluation
- Claims analysis
- Conflict resolution
- Analytical problem-solving
- Prioritization skills
- Detail-oriented approach
- Proficient in managing multiple tasks
- Self-driven initiative
Timeline
Claims Resolution Analyst
Centene
08.2020 - 09.2026
Medical Claim Adjustor
Nationwide Insurance
10.2013 - 01.2020
Property Claims Adjustor
Nationwide Insurance
10.2012 - 10.2013
Underwrite Assistance/Commercial SR Processor
Nationwide Insurance
01.2005 - 10.2012
Bachelor’s Degree - Organizational Management, Human Resources Management, International Human Resource
Ashford University