Summary
Overview
Work History
Education
Skills
Timeline
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APRIL R. BROWN

Brown Deer,Wisconsin

Summary

With eight years of claim processing experience, I have developed expertise in handling self-funded and fully-funded Medicaid and Medicare insurance. Thriving in fast-paced environments, I excel at multitasking and delivering exceptional results. My skill set includes customer service, medical claims processing, and proficiency in ICD-10 coding. Highly adaptable and able to work independently, I utilize provided information to effectively learn and perform duties. Committed to delivering accurate and efficient results, I am a seasoned claim processor.

Overview

16
16
years of professional experience

Work History

Sr. Claims Benefit Specialist

CVS Health
10.2017 - Current
  • Enhanced claim processing efficiency by conducting thorough investigations and maintaining accurate documentation.
  • Managed large volume of medical claims on daily basis.
  • Maintained knowledge of benefits claim processing, claims principles, medical terminology, and procedures and HIPAA regulations.
  • Read over insurance policies to ascertain levels of coverage and determine whether claims would receive approvals or denials.
  • Used administrative guidelines as resource or to answer questions when processing medical claims.
  • Evaluated and settled complex insurance claims in strict timeframes.
  • Determined appropriateness of payers to protect organization and minimize risk.
  • Developed customized training materials to enhance the effectiveness of employee onboarding programs.
  • Mentored junior staff members, developing their skills in claim analysis, negotiation, and settlements.

Complaints and Grievances Specialist

DentaQuest
04.2016 - 06.2017
  • Promoted a culture of continuous learning and development within the Grievance Appeals team, encouraging skill growth and knowledge sharing.
  • Conducted thorough investigations for complex cases, ensuring fair and accurate outcomes.
  • Reduced case backlog significantly through diligent review and resolution of pending grievances.
  • Maintained compliance with regulatory requirements by staying current on industry standards and guidelines.
  • Demonstrated exceptional problem-solving skills when faced with unique or challenging cases, resulting in successful resolutions that satisfied all parties involved.
  • Displayed excellent time management skills while managing multiple high-priority cases concurrently without compromising quality or attention to detail.
  • Streamlined communication channels among departments, leading to faster case resolutions and improved interdepartmental collaboration.

Claims Processor

Molina Health Care
03.2015 - 04.2016
  • Adjudicate Medicare/ Medicaid claims and took proper actions to resolve discrepancies
  • Work backlog of denied/rejected claims for prompt resubmission
  • Manage assigned queues keeping up to date and current on all claims and meeting productivity criteria
  • Follow all applicable Medicare/Medicaid and Wisconsin regulations including HIPAA
  • Managed high volume of claims, prioritizing tasks to meet deadlines without sacrificing quality.
  • Reviewed and analyzed claims to ensure accuracy, completeness, and compliance with company policies.
  • Handled escalated customer concerns regarding claim denials or delays with empathy and professionalism.
  • Ensured compliance with all regulatory requirements, staying up-to-date with changes and conducting regular training.
  • Developed strong relationships with insurance providers, facilitating efficient communication for faster resolution of outstanding claims.

Member Support Specialist

Assurant Health
07.2013 - 07.2014
  • Enhanced member satisfaction by promptly addressing and resolving inquiries and concerns.
  • Developed strong relationships with members through empathetic communication and effective problem-solving skills.
  • Nurtured a positive work environment that promoted collaboration among colleagues and fostered a culture focused on continuous improvement.
  • Managed high call volumes while maintaining a professional demeanor and providing accurate information to each caller.
  • Trained new team members in best practices for efficient and consistent member support delivery.

Account Receivables Internal Analyst

Brookdale Senior Living
09.2011 - 07.2013
  • Conducted regular reviews of aged accounts receivable reports, ensuring timely follow-up on past due balances.
  • Demonstrated expertise in billing software, troubleshooting issues and providing guidance to colleagues as needed.
  • Reduced billing errors with diligent review of invoices, ensuring accuracy in charges and client information.
  • Prepared itemized statements, bills, or invoices and recorded amounts due for items purchased or services rendered.
  • Generated monthly billing and posting reports for management review.
  • Served as an escalation point for high-priority issues, leveraging extensive technical expertise to resolve complex problems efficiently and effectively.
  • Enhanced regional support by streamlining communication processes and implementing efficient troubleshooting techniques.

Collections Team Lead

Wells Fargo Home Mortgage
06.2008 - 09.2011
  • Streamlined collections processes, leading to improved efficiency and reduced delinquent accounts.
  • Enhanced team performance by implementing effective training programs and providing consistent feedback.
  • Continuously evaluated team performance metrics and adjusted strategies accordingly to ensure consistent achievement of established targets in mortgage collections operations.
  • Led regular team meetings to discuss progress against goals, address challenges faced by collectors, share best practices, and foster a sense of camaraderie within the group.
  • Managed a high-performing team of collectors, consistently meeting or exceeding established targets and goals.
  • Assisted in resolving escalated customer complaints by utilizing advanced negotiation skills and demonstrating empathy towards borrowers'' circumstances while maintaining business objectives.

Education

Associate Degree - Science

Milwaukee Area Technical College
Milwaukee, WI
05.2019

Skills

  • Claims Management Expertise
  • Attention to detail and accuracy
  • Superior organizational skills
  • Financial Analysis Competence
  • Critical Thinking Capabilities
  • Extensive Insurance Industry Experience
  • Multitasking and prioritization
  • Strong communication abilities
  • Insurance knowledge
  • Claims Processing
  • Microsoft Office
  • Computer Proficiency
  • Claims adjustment
  • Medicaid knowledge

Timeline

Sr. Claims Benefit Specialist

CVS Health
10.2017 - Current

Complaints and Grievances Specialist

DentaQuest
04.2016 - 06.2017

Claims Processor

Molina Health Care
03.2015 - 04.2016

Member Support Specialist

Assurant Health
07.2013 - 07.2014

Account Receivables Internal Analyst

Brookdale Senior Living
09.2011 - 07.2013

Collections Team Lead

Wells Fargo Home Mortgage
06.2008 - 09.2011

Associate Degree - Science

Milwaukee Area Technical College

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APRIL R. BROWN