Ashley Richter
Hopkins,South Carolina
Summary
Dedicated Customer Advocate Representative providing skills to prioritize and multi-task in a fast-paced working environment. I successfully work as part of a team to reach personal and business goals. I am also known for successfully handling escalated situations that may require immediate attention. At this time, I am seeking a challenging position in a reputed organization where I can learn new skills, expand my knowledge and leverage my learnings.
Overview
11
11
years of professional experience
Work History
Claim Representative
Cigna-Evernorth
05.2023 - Current
- Perform full review of claim codes and manage claims from start to finish ensuring timely and accurate resolution
- Use internal tools and platforms to access claims, determine correct coding and make necessary repairs to claim ICD CM codes for diagnosis and complications, and CPT/HCPCS codes for surgeries, procedures, evaluation and management services, and inpatient professional services
- Conduct thorough reviews and apply critical thinking to evaluate claims and ensure that it supports diagnostic and procedural codes assigned, and is consistent with required medical coding nomenclature
- Use various computer applications to abstract records, assign codes, and record and transmit data
Underwriter Support Analyst
Mutual Of Omaha
05.2018 - 04.2023
- Served as the first point of contact for producers and policyholders for life and health insurance.
- Conducted risk analysis and help producers and policyholders understand the requirements needed to finish the underwriting process
- Empathetically listened to Financial Professionals and their clients concerns, providing emotional support during challenging situations, and offered solutions that meet their current and future needs
Benefits Verification Specialist
Capital Blue Cross
09.2014 - 04.2018
- Directly consulted with members and patients regarding their medical, dental, and vision health benefits via incoming calls
- Directly consulted with the clinical staff for clarification of conflicting, incomplete, or ambiguous clinical data in the health record via incoming or outgoing calls
- Helped the claim examiners code all complicated and complex medical/specialty diseases processes, patient injuries, and all medical procedures in a wide range of ambulatory/inpatient settings and specialties
- Assisted agents with handling calls and took over escalated concerns to deliver expert solutions
Education
High School Diploma -
Lockport Township High School
Lockport, ILSkills
- Familiarity with insurance claims processes and regulations
- Critical thinking and problem solving ability
- Verbal and written communication with strong customer service mindset
- Empathetic and compassionate
- Excellent analytical and organizational skills
- Ability to work independently and manage multiple claims simultaneously
- Attention to detail
Timeline
Claim Representative
Cigna-Evernorth
05.2023 - Current
Underwriter Support Analyst
Mutual Of Omaha
05.2018 - 04.2023
Benefits Verification Specialist
Capital Blue Cross
09.2014 - 04.2018
High School Diploma -
Lockport Township High School