Ashley Zimmerman
Camp Hill,PA
Summary
Diligent Claims Processor versed in insurance processes and claims procedures. Offers great attention to detail and time management abilities to successfully handle large volume of claims. Highly accurate and thorough with focus on completing error-free work in line with processing guidelines.
Overview
10
10
years of professional experience
Work History
Claims Processor
Highmark Health
09.2015 - Current
- Managed high volume of claims, prioritizing tasks to meet deadlines without sacrificing quality.
- Reviewed applications and supporting documents to verify claims eligibility and accuracy.
- Managed workload and priorities to meet claims processing meet deadlines.
- Collaborated with cross-functional teams to resolve complex claims issues efficiently and effectively.
- OSCAR Mainframe user.
- OCWA User.
- KML User.
- Utilizes multiple Miscrosoft 365 applications such as Excel, Outlook and Teams.
- Handled IBC claims adjustments both Local and BlueCard.
- Handled AHNJ claims adjustments.
- Corrected claim specialist.
- Handled Reno report and Out of Balance report.
- Handled CFID, Dental, Appeal and priority adjustments.
- Assisted with Mentoring & trainings.
- Assisted in IBC, AHNJ and Covid-19 clean-up projects and workarounds.
- Assist with managing IBC’s Real time adjustment chat.
- IBC NDC Pricing Specialist.
Associate Claims Processor
Highmark Health
04.2014 - 09.2015
- 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.
- IBC SOW Claims processing
- Trained new employees on claims processing procedures, contributing to a well-prepared workforce.
- Corrected Claim Specialist
- Assisted in IBC Clean-up projects.
- Researched and resolved complex medical claims issues to support timely processing.
- OSCAR Mainframe user.
- OCWA User.
- OPIS User- Used to verify if patient or dependents for COB, Auto/Motor and Workers Compensation.
- Evaluated medical claims for accuracy and completeness and researched missing data.
Education
High School Diploma -
East Pennsboro Area Senior High School
05.2009
Skills
- Critical Decision-Making
- Organizational abilities
- Customer Service
- Adaptability
- Time Managment
- Conflict Resolution
- Knowledgeable in ODS
- Mentoring Experience
- Knowledgeable in Utilizing multiple Highmark specific applications such as OCWA
- Fast Learner
- Team Player
Accomplishments
- Achieved the Higher Marks reward 3 years in a row by processing claims with accuracy and efficiency.
Affiliations
- Stephanie Meadath- (717)-999-3293 Stephanie.Meadath@Highmark.com- Associate Investigator FIPR In source Team.
- Erin Brown- Erin.Brown@Highmark.com- Former Supervisor on the IBC BPS 3 Claims adjustment team.
Timeline
Claims Processor
Highmark Health
09.2015 - Current
Associate Claims Processor
Highmark Health
04.2014 - 09.2015
High School Diploma -
East Pennsboro Area Senior High School