Summary
Overview
Work History
Education
Skills
Certification
Timeline
Generic

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
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
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
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
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

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
Ann Marie Racette