Arial Duke
Marion,Iowa
Summary
Claims Examiner with expertise in processing medical insurance claims, reviewing medical documentation, and collaboration with internal teams. Experience with adjustments and appeals and grievances. Possess strong problem solving skills with proven ability to improve processes and develop training resources.
Overview
8
8
years of professional experience
Work History
Claims Examiner
Molina Healthcare Inc./Firstsource Solutions
Marion, Iowa
05.2023 - Current
- Review and analysis of insurance claims to determine validity and adherence to policies and regulations.
- Utilize industry-standard software such as QNXT, PEGA and Salesforce to efficiently manage claims processing, provider appeals and claim adjustments.
- Training and mentoring other claims examiners on best practices and company policies.
- Analyze claims data to identify trends and recommend improvements to improve accuracy.
- Actively participate in team meetings to discuss claim challenges and share best practices for improvement.
Billing and Insurance Specialist
Southeast Iowa Regional Medical Center
West Burlington, IA
06.2022 - 04.2023
- Analyzed claim and medical data to submit to payers for reimbursement purposes.
- Developed training materials.
- Attended meetings with team, leadership and insurance company representatives to discuss plan details and identify and resolve issues within claim data.
- Communicated with patients in regards to patient claims and accounts.
Charge
ImpactLife
Burlington, IA
09.2019 - 11.2021
- Supervision of blood product collections, documentation and daily operations.
- Provided training and education to staff.
Disability Representative
Sedgwick
Cedar Rapids, IA
05.2018 - 06.2019
- Processed short term disability and FMLA claims by collaborating with applicants and medical providers to obtain necessary documentation in order to conduct thorough assessments to determine eligibility for leaves of absence and benefits.
- Provided guidance and support to applicants in navigating benefits and services.
Education
Some college - Social Sciences
Kirkwood Community College
Cedar Rapids, IA01.2015
High School - undefined
Fort Madison High School
Fort Madison, IA01.2014
Skills
Training Development
Mentorship
Claims Analysis
Communications
Supervision/Team management
MS Office
Customer service
Team building
Timeline
Claims Examiner
Molina Healthcare Inc./Firstsource Solutions
05.2023 - Current
Billing and Insurance Specialist
Southeast Iowa Regional Medical Center
06.2022 - 04.2023
Charge
ImpactLife
09.2019 - 11.2021
Disability Representative
Sedgwick
05.2018 - 06.2019
High School - undefined
Fort Madison High School
Some college - Social Sciences
Kirkwood Community College