Ashley Negron
Monroeville,PA
Summary
Detail-oriented and customer-focused claims professional with over 3 years of experience in medical claims processing and workers' compensation. Expertise in managing medical-only claims, assessing compensability, and ensuring compliance with industry regulations. Skilled in verifying policy coverage, establishing reserves, and communicating effectively with claimants, clients, and healthcare providers. Strong understanding of medical terminology, claims documentation, and claims management software. Known for a collaborative approach to working with cross-functional teams while also excelling in independent tasks. Seeking to leverage my claims handling experience and customer service skills to contribute to the success a company
Overview
7
7
years of professional experience
1
1
Certification
Work History
Technical Administrative Assistant
Gallagher Bassett
09.2022 - Current
- Managed medical claims documentation, ensuring accuracy in the review and processing of non-complex claims
- Worked closely with claims adjusters to ensure proper claim handling and ensure all client requirements were met within guidelines
- Provided support in the completion of medical claim error reports, helping to resolve discrepancies and improve claims accuracy
- Assisted in the coordination and management of medical-only claims, ensuring timely updates to claimants, clients, and internal teams
- Authored clear and professional communications regarding claim status and next steps for customers, claimants, and clients
- Developed strong knowledge of claims processing protocols, medical terminology, and industry regulations
Claims Examiner
UPMC
03.2019 - 02.2021
- Handled medical-only claims, confirming policy coverage and determining the validity and compensability of each claim under close supervision
- Set reserves and authorized payments for claims within established limits, adhering to company and client guidelines
- Ensured compliance with all claims protocols, including workers’ compensation regulations, and participated in claims reviews as necessary
- Managed communication with claimants and clients, updating them on the status of their claims and resolving any issues that arose
- Collaborated with senior claims professionals to review complex claims and ensure proper handling of more challenging cases
- Developed a strong understanding of medical claims, including ICD/CPT coding, as well as workers’ compensation laws and practices
Intake Coordinator
UPMC
08.2017 - 03.2019
- Processed new claims related to Short-Term Disability, Workers' Compensation, and Leave Management, gathering necessary information to determine eligibility
- Provided customer service to claimants, explaining claim processes and assisting with claim-related inquiries
- Trained and mentored new team members on claims intake processes, ensuring they adhered to guidelines and maintained high levels of accuracy
- Worked closely with medical providers and claims teams to verify medical information and ensure claims were processed in compliance with legal and regulatory standards
- Maintained accurate records and participated in team meetings to provide insights and improve team processes
Education
Associate of Science - General Studies
Community College of Allegheny County
Pittsburgh, PA05.2025
Skills
- Exceptional communication skills
- Quick learner
- Excellent team player and community builder
- Medical terminology knowledge
- Administrative Procedures
- Administrative Support
- Microsoft Office
Certification
Claims Adjuster, TX License number 3133407
Custom
Mobile Notary Pittsburgh, PA & Surrounding Areas, 1413335, E&O Insured, Licensed & Bonded
Timeline
Technical Administrative Assistant
Gallagher Bassett
09.2022 - Current
Claims Examiner
UPMC
03.2019 - 02.2021
Intake Coordinator
UPMC
08.2017 - 03.2019
Associate of Science - General Studies
Community College of Allegheny County