Ashley Brown
Collinsville,IL
Summary
Talented and high-performing college undergraduate with extensive experience performing successfully in fast-paced environments. Passionate about business success and successful at supporting all staff and customer needs. Committed and motivated with outstanding customer service and decision-making skills. Strong work ethic, professional demeanor and great initiative. Excellent prioritizing, multitasking and follow-through skills useful for achieving project goals. Desiring the opportunity to leverage education and experience to take on new challenges with an established company.
Overview
4
4
years of professional experience
1
1
Certification
Work History
Claims Analyst
CVS Healthcare
Collinsville, IL
03.2023 - Current
- Review provider and member claims to determine if they meet CCR review requirements.
- Follow applicable workflows, templates, and legal and compliance requirements to provide a complete picture of what is requiring review to the CCR clinicians and medical directors.
- Organizes and prioritizes work to help meet regulatory and CCR claim turn around times.
- Determines coverage, verifies eligibility, benefits, identifies discrepancies, and applies all Medical Claim Management policies and procedures to assist in ensuring claims are handled per policy and legal requirements.
- Works with all appropriate internal and external departments and personnel to accurately review specified claims and/or clarify any issues found in the course of the review.
- Maintains and utilizes all resource materials and systems to effectively manage job responsibilities.
- Researched applicable laws and regulations related to insurance policies and procedures.
- Advised customers on filing requirements, documentation needed, and other matters pertaining to their claims.
- Provided guidance to customers regarding their rights and obligations under policy terms.
Team Lead/Supervisor
Saint Clair Communications
O'Fallon, IL
01.2022 - 10.2022
- Manage the workflow of their team by assigning tasks, supporting staff, and monitoring results.
- Directly supervise team and provide feedback. Uses established processes and tools to monitor performance and use those metrics to provide meaningful feedback focused on improvements.
- Overcome objections and re-direct conversation for optimum outcomes.
- Work as Manager on Duty during designated shifts.
- Provided leadership and guidance to team members, ensuring that tasks were completed on time and to a high standard.
- Ensured compliance with company policies and procedures throughout the team.
- Monitored team performance against targets, taking corrective action where necessary.
- Assisted the manager in setting achievable goals for the team while monitoring progress towards them.
- Reviewed existing systems and procedures regularly, suggesting ways they could be improved or optimized.
- Organized and prioritized incoming work orders and optimized team workflows and resources to handle dynamic demands.
Claims Specialist
UnitedHealth Group
Schaumburg, IL
11.2019 - 02.2020
- Responsible and accountable for the accurate and timely claims processing of all claim types.
- Ensured claims were processed with a high level of detailed quality and in accordance with claims payment policy and by the terms of our customer/provider contractual agreements.
- Adjudicates claims and adjustments as required. Resolves claims edits and suspended claims.
- Maintains and updates required reference materials to adjudicate claims.
- Provides backup support to other team/group members in the performance of job duties as assigned.
- Assisted with filing appeals on denied claims with insurance companies.
- Provided customer service by responding promptly to inquiries from claimants regarding their benefits or coverage.
- Advised management on potential changes needed in policies or procedures based on findings from investigations.
Education
High School Diploma -
East Leyden High School
Franklin Park04.2011
BBA - Business Administration
Trident University International
Cypress, CASkills
- Accounting Spreadsheets
- Interpersonal and Written Communication
- Customer Relationship Management
- Relationship Management
- Customer Service/customer Care
- Organizational Development
- Dispute Mediation
- Microsoft Office Proficiency
- Microsoft Office and Docusign
- Records Management
- Training and Mentoring
- Human Resources Operations
Certification
- CPR and First Aid Certified
Languages
English
Professional
References
References available upon request.
Timeline
Claims Analyst
CVS Healthcare
03.2023 - Current
Team Lead/Supervisor
Saint Clair Communications
01.2022 - 10.2022
Claims Specialist
UnitedHealth Group
11.2019 - 02.2020
High School Diploma -
East Leyden High School
BBA - Business Administration
Trident University International