Open To Work
Arnetta Abbey
Work Preference
Summary
Analytical professional with extensive experience in business analysis, benefit coordination, and insurance claims processing. Skilled in training and staff development while effectively connecting technology and support teams with business units. Excels in problem-solving and addressing diverse issues, fostering strong relationships with peers and management.
Overview
14
14
years of professional experience
Work History
Regulated Claims Settlement Coordinator
Zelis, Medix
01.2025 - 07.2026
- Prepared and presented response packages for arbitration cases at state and federal levels under NSA.
- Guided selection process for certified arbitration entities under NSA to ensure alignment with standards.
- Developed scalable IDR defense package through enhanced automation of data creation and compilation.
- Ensured all documentation adhered to Zelis standards for privacy compliance, legal aspects, and HIPAA.
- Monitored compliance of all cases with required timelines for responses and necessary Zelis input.
- Executed multiple tasks to support efficient departmental operations.
Claims Liaison / Amisys
Populus Group
Troy, USA
07.2023 - 02.2024
- Collaborated with business units to ensure prompt, accurate claims adjudication, enhancing overall service delivery.
- Liaised between health plan and claims department to facilitate timely resolutions, improving claims processing efficiency.
- Validated appropriate reason codes for claims to ensure correct payments, eliminating incorrect denial codes and reducing rework.
- Utilized Microsoft Excel efficiently to manipulate and organize business data.
Claims Adjustor / Amisys
Catalyst Solutions
Denver, USA
08.2022 - 03.2023
- Facilitated communication among all parties to expedite claims processing and improve resolution times.
- Adjusted claims from Utilization Review, ensuring accurate and timely payment.
- Consistently met production standards with an accuracy rate of 99%.
Temporarily Lead Claim Examiner (Healthcare) Claims Analyst / Facets, Powerstepp
Jacobson
Chicago, USA
01.2020 - 07.2022
- Validated claims with precision, ensuring timely payments and reducing processing errors.
- Processed claims efficiently, eliminating incorrect denial codes and reducing rework.
- Managed a variety of claim types, including Medical, Dental, Medicaid, VA, and COB.
- Coordinated benefits for copays, coinsurance, and deductibles with other insurance providers, including Medicare and Medicaid.
- Conducted daily claim audits, resolved processing queries, and provided training on new procedures.
- Analyzed daily backlog reports to identify trends, producing comprehensive end-of-week summaries for management review.
- Optimized workflow by delegating tasks effectively to staff.
- Leveraged Excel for efficient data export and import tasks.
Business Analyst I / Amisys
Nebraska Total Care
Omaha, USA
08.2017 - 10.2018
- Collaborated with key stakeholders to design, document, and maintain system processes, enhancing operational efficiency.
- Conducted in-depth data analysis, improved monitoring systems, identified issues, and delivered enhanced value and solutions to clients.
- Utilized SQL to gather, analyze, and report on data trends, providing technical reports and summaries to the project team.
- Developed project plans, monitored performance metrics, and managed projects from inception to completion, ensuring alignment with objectives.
- Led project meetings, communicated insights, and formulated strategies to address and resolve identified gaps.
Senior Claims Examiner
Meridian Health Plan
Detroit, USA
02.2012 - 07.2017
- Supervised team of claim examiners, ensuring timely claims processing, assisting with policy interpretation, and making final decisions on third-party liability investigations to uphold compliance and stakeholder satisfaction.
- Leveraged data analytics to troubleshoot and resolve claims issues in Provider Network Development and related functions, improving overall claims accuracy.
- Utilized proprietary MCS System to streamline claims processing, enhancing turnaround times and service delivery.
- Determined accurate benefit amounts for timely claim payments., approved claim payments, and settled claims within the designated authority level.
Education
Bachelor of Applied Science - Business Administration
Central Michigan University
Southfield, MISkills
- Claims Processing
- Facets
- PowerStepp
- QNXT
- Amisys
- SQL
- Data Analysis
- Workflow Optimization
- Microsoft Office
- Health Care
- Appeals and Grievances
- Problem-Solving
- Critical Thinking
- Detail Oriented
- Time management techniques
- Communication
- Interpersonal Skills
Timeline
Regulated Claims Settlement Coordinator
Zelis, Medix
01.2025 - 07.2026
Claims Liaison / Amisys
Populus Group
07.2023 - 02.2024
Claims Adjustor / Amisys
Catalyst Solutions
08.2022 - 03.2023
Temporarily Lead Claim Examiner (Healthcare) Claims Analyst / Facets, Powerstepp
Jacobson
01.2020 - 07.2022
Business Analyst I / Amisys
Nebraska Total Care
08.2017 - 10.2018
Senior Claims Examiner
Meridian Health Plan
02.2012 - 07.2017
Bachelor of Applied Science - Business Administration
Central Michigan University