Ann Marie Racette
Elkhorn,NE
Summary
Proven Senior Claims Specialist with a robust background at The Hartford, adept in leveraging organizational skills and critical thinking to drive efficiency and mentor team members. Excelling in communication, I spearheaded initiatives that significantly enhanced claims processing, demonstrating a strong blend of leadership and adaptability. Results-driven professional with proven ability to effectively manage high-volume claims while maintaining accuracy and efficiency. Skilled in determining coverage, verifying facts, negotiating settlements, and preparing clear, concise reports. Excellent communicator with strong customer service and problem-solving capabilities. Proven ability to provide excellent customer service and resolve customer complaints in a timely manner. Possesses strong problem-solving skills and the ability to multitask in a fast-paced environment. Aiming to leverage my abilities to successfully fill the [Job Title] role on your team.
Overview
11
11
years of professional experience
1
1
Certification
Work History
SENIOR CLAIMS EXAMINER
Physicians Mutual
Omaha, NE, USA
09.2024 - Current
- Reviewed, evaluated and processed complex long term care claims for payment accuracy according to established guidelines.
- Developed relationships with insured clients and facilities to facilitate timely reimbursement for services rendered.
- Communicated effectively with internal auditors regarding updates on pending claims status changes.
SENIOR CLAIMS SPECIALIST
Illumifin
Omaha, NE, USA
06.2021 - 08.2024
- Monitored claim status updates from adjusters and underwriters to ensure timely completion of the claims process.
- Mentored team members in understanding the proper application of applicable laws and regulations governing insurance policies.
- Conducted comprehensive research on claim related matters using multiple sources including policy language, state regulations, court decisions.
- Developed and maintained strong relationships with internal and external customers to ensure timely resolution of claims processing.
- Trained new staff members on claims handling protocols and procedures.
- Utilized advanced problem-solving skills to identify solutions that met both customer and company needs.
CLAIMS INTAKE SPECIALIST
The Hartford
Omaha, NE, USA
08.2014 - 06.2021
- Ensured accurate interpretation of policy language during review process.
- Provided timely follow-up on outstanding issues related to claim processing.
- Processed requests for additional information or documentation as needed.
- Analyzed claim documents for accuracy and completeness to ensure regulatory compliance.
- Demonstrated excellent customer service skills while responding to inquiries from internal and external customers.
- Researched complex cases to determine eligibility requirements and coverage limits.
- Collaborated with internal departments regarding changes in policy or procedure updates.
CLAIMS INTAKE SPECIALIST
The Hartford
Omaha, NE, USA
08.2014 - 06.2021
- Ensured accurate interpretation of policy language during review process.
- Provided timely follow-up on outstanding issues related to claim processing.
- Processed requests for additional information or documentation as needed.
- Analyzed claim documents for accuracy and completeness to ensure regulatory compliance.
- Demonstrated excellent customer service skills while responding to inquiries from internal and external customers.
- Researched complex cases to determine eligibility requirements and coverage limits.
- Collaborated with internal departments regarding changes in policy or procedure updates.
Education
Medical Coding And Billing - Medical Coding And Billing
Purdue Global
05.2024
Skills
Developed and implemented communication protocols to streamline information flow
Employed adaptive strategies to effectively navigate diverse challenges and situations
Applied analytical skills to identify and resolve complex issues, ensuring seamless workflow
Utilized critical thinking skills to assess information and make informed decisions that support project objectives
Utilized strong organizational skills to enhance team efficiency and productivity
Facilitated team leadership initiatives to drive project success and achieve organizational goals
Implemented strategic time management techniques to streamline operations
Leveraged claims management expertise to enhance operational efficiency and customer satisfaction
Employed specialized investigative tools to support thorough examinations and uncover critical insights
Oversaw claims analysis processes to enhance accuracy and efficiency Collaborated with cross-functional teams to streamline claim resolution workflows Championed initiatives to improve claims handling procedures
Analyzed and evaluated claims to support effective decision-making and risk management
Led collaborative initiatives across departments to enhance project outcomes and team synergy Championed teamwork principles to drive engagement and accountability among team members Cultivated a culture of collaboration that improved overall project efficiency
Oversaw coordination of various projects to enhance team efficiency and productivity Facilitated communication among team members to streamline task execution Championed initiatives that improved workflow and resource allocation
Applied analytical skills to identify issues and develop effective solutions for operational efficiency
Implemented effective time management strategies to streamline workflow and meet deadlines
Time management
Certification
NHA Certified Billing and Coding Specialist
Timeline
SENIOR CLAIMS EXAMINER
Physicians Mutual
09.2024 - Current
SENIOR CLAIMS SPECIALIST
Illumifin
06.2021 - 08.2024
CLAIMS INTAKE SPECIALIST
The Hartford
08.2014 - 06.2021
CLAIMS INTAKE SPECIALIST
The Hartford
08.2014 - 06.2021
Medical Coding And Billing - Medical Coding And Billing
Purdue Global