Annice Washington
Romulus
Summary
Professional claims specialist with strong background in auditing and compliance. Expertise in identifying discrepancies, analyzing data, and ensuring accuracy in claims processing. Known for effective team collaboration, adaptability, and delivering consistent results. Highly skilled in problem-solving, communication, and maintaining high standards in fast-paced environment.
Overview
22
22
years of professional experience
Work History
Disability Claims Auditor
Elevance Health
02.2016 - 03.2024
- Managed a diverse caseload of claims while maintaining attention to detail and accuracy under time-sensitive conditions.
- Improved interdepartmental workflows by proactively addressing communication gaps or process inefficiencies, fostering a more productive work environment.
- Conducted through review of claim files, medical records, and other supporting documentation.
- Participated in ongoing professional development opportunities to stay current on industry trends, enhancing personal skill set and benefitting the organization.
- Identified fraudulent activities by conducting detailed audits on suspicious claims, protecting company resources.
Disability Representative
Sedgwick CMS
03.2012 - 01.2016
- Identified opportunities for continuous improvement within the department, implementing changes that enhanced overall service quality and efficacy in assisting disabled individuals.
- Provided compassionate support to clients during difficult life transitions due to illness or injury, fostering positive relationships with claimants and their families.
- Collaborated with medical professionals to gather pertinent information for accurate decision-making on disability claims.
- Streamlined internal processes to enhance team efficiency and productivity in managing caseloads.
- Managed complex cases involving multiple diagnoses or challenging circumstances, demonstrating exceptional problem-solving skills in navigating logistical hurdles.
Claims Examiner
Transamerica Life
06.2002 - 02.2012
- Utilized analytical skills to evaluate medical claims for accuracy and appropriateness of charges before approving payments as part of the claims process.
- Maintained detailed records of all claims activities, ensuring compliance with regulatory requirements and company policies.
- Mitigated fraud risks by identifying suspicious patterns in claims data and escalating concerns to appropriate teams for further investigation.
- Read over insurance policies to ascertain levels of coverage and determine whether claims would receive approvals or denials.
- Handled sensitive information with discretion, ensuring confidentiality of personal and financial details for claimants throughout the claims examination process.
Education
Michigan State University
East Lansing, MISkills
- Team collaboration
- Claims processing
- Exemplary communication skills
- Compliance and regulations
- Critical thinking
- Analytical thinking
- Customer service
- Time management
Timeline
Disability Claims Auditor
Elevance Health
02.2016 - 03.2024
Disability Representative
Sedgwick CMS
03.2012 - 01.2016
Claims Examiner
Transamerica Life
06.2002 - 02.2012
Michigan State University
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