April Allen
Columbus,GA
Summary
Forward-thinking Operations Specialist bringing 20 years of expertise in Claims Operations and Customer Service for Supplement Indemnity and Major Medical sector of businesses. Cultivates rapport with individuals to optimize project goals and output, resolve complex problems and deliver innovative improvement strategies. Proficient in Microsoft Word, Excel, and Access and Medical Terminology. Organized and dependable candidate successful at managing multiple priorities with a positive attitude. Willingness to take on added responsibilities to meet team goals. Detail-oriented team player with strong organizational skills. Ability to handle multiple projects simultaneously with a high degree of accuracy. To seek and maintain full-time position that offers professional challenges utilizing interpersonal skills, excellent time management and problem-solving skills.
Overview
19
19
years of professional experience
Work History
Claims Examiner
Webtpa
Remote
11.2023 - Current
- Maintained detailed records of all claims activities, ensuring compliance with regulatory requirements and company policies.
- Read over insurance policies to ascertain levels of coverage and determine whether claims would receive approvals or denials.
- Examined claims forms and other records to determine insurance coverage.
- Identified insurance coverage limitations with thorough examinations of claims documentation and related records.
- Handled sensitive information with discretion, ensuring confidentiality of personal and financial details for claimants throughout the claims examination process.
- Utilized analytical skills to evaluate medical bills for accuracy and appropriateness of charges before approving payments as part of the claims process.
Claims Lead Representative
Cigna Health Group
Remote
11.2022 - 01.2024
- Enhanced customer satisfaction by addressing and resolving complex issues promptly and professionally.
- Exceeded performance targets by consistently delivering high-quality work in a fast-paced environment.
- Developed and maintained positive customer relations and coordinated with team members to properly handle requests and questions.
- Updated job knowledge by participating in educational opportunities, reading professional publications, and maintaining personal networks.
- Developed strong relationships with clients to ensure a high level of service and ongoing support.
Claims Operations Specialist
Aetna
Remote
11.2021 - 07.2023
- Generated, posted and attached information to claim files.
- Checked documentation for accuracy and validity on updated systems.
- Carried out administrative tasks by communicating with clients, distributing mail, and scanning documents.
- Maintained confidentiality of patient finances, records, and health statuses.
- Maintained strong knowledge of basic medical terminology to better understand services and procedures.
- Resubmitted claims after editing or denial to achieve financial targets and reduce outstanding debt.
- Determined appropriateness of payers to protect organization and minimize risk.
Claims Specialist III
Aflac
Columbus, GA
01.2006 - 12.2021
- Reviewed supplemental insurance and indemnity claims documents to verify required information and secure any missing data for payment.
- Followed up with customers on unresolved issues.
- Monitored compliance with regulations and industry best practices to promote fair and proper treatment for insured customers.
- Performed administrative duties by verifying documentation, researching facts and contacting other parties involved to determine fault percentages and minimize potential losses.
Education
Computer And Information Sciences
Alabama State University
Montgomery, ALComputer And Information Sciences
Columbus Technical College
Columbus, GASkills
- Production Operations
- Task Management
- Teamwork Skills
- Problem-Solving and Reasoning
- Team Goals
- Closing Procedures
- Continuous Improvement Process
- Verbal and Written Communication
Timeline
Claims Examiner
Webtpa
11.2023 - Current
Claims Lead Representative
Cigna Health Group
11.2022 - 01.2024
Claims Operations Specialist
Aetna
11.2021 - 07.2023
Claims Specialist III
Aflac
01.2006 - 12.2021
Computer And Information Sciences
Alabama State University
Computer And Information Sciences
Columbus Technical College