Barbara Dyson
Rosedale,MD
Summary
Seasoned internal audit/compliance audit professional with knowledge of GAAP, GAGAS, and IIA Standards as well as excellent interpersonal skills and excellent collaboration skills. Detail-oriented Examiner with 7 years of experience. Strong command of conflict resolution and negotiation combined with excellent reporting and research skills. Thorough understanding of claims process in the health care industry.
Overview
25
25
years of professional experience
1
1
Certification
Work History
Claims Analyst
Jacobson Online
09.2022 - 07.2023
- Maintained strict confidentiality with all personal data as per company guidelines.
- Managed high-volume caseloads, prioritizing tasks to ensure timely completion of all claims.
- Maintained compliance with industry regulations and company policies while managing sensitive client information and claims records.
- Enhanced customer satisfaction by resolving complex claims issues in a timely manner.
Provider Customer Service Representative
Hornet Staffing (Tricare)
06.2022 - 02.2023
- Answered inbound calls from providers regarding credentialing and health care claims issues
- Enhanced customer satisfaction by efficiently addressing and resolving inquiries in a timely manner.
Implemented effective problem-solving techniques, providing tailored solutions for individual customer concerns. - Coordinated with internal departments to resolve escalated issues promptly and effectively.
- Navigated complex databases and systems, retrieving accurate information to assist clients effectively.
- Experienced with cpt coding, coordination of benefits and Medicare claims.
Claims Representative
Jacobsons Insurance Talent
08.2021 - 08.2021
- Answered inbound calls from providers regarding their credentialing status, address updates and patient claims.
- Worked productively in fast-moving work environment to process large volumes of claims.
- Improved customer satisfaction by providing timely and accurate information on claim status and resolution.
- Researched and analyzed complex claims to determine next steps and possible outcomes.
- Maintained compliance with industry regulations by adhering to established procedures and guidelines in claims handling.
- Analyzed and addressed escalated claims to resolve issues quickly.
Internal Auditor
BLUE CROSS AND BLUE SHIELD ASSOCIATION
01.2015 - 12.2019
- Reviewed Plan internal controls to ensure compliance with the Government-wide Service Benefit Plan contract (CS 1039)
- Reviewed Plan internal controls over Fraud, Waste, and Abuse in accordance with CS 1039
- Audited Plan execution of BCBSA QAR Program to ensure metrics utilized to calculate annual Plan payouts were in accordance with the CS 1039 contract
- Analyzed performance results and lead cross-functional meetings with Plan stakeholders in order to facilitate the development and completion of action plans for each performance program included the QAR Program
- Participated in the development and administration of various audit initiatives/programs that impact internal and external stakeholders
- Provided Plans education and support by helping them to understand and properly execute operational and audit requirements for the QAR Program in both formal and informal settings on a scheduled or ad-hoc basis.
Claims Examiner
GEICO INSURANCE COMPANY
01.2011 - 12.2013
- Examined claim forms and other records to determine insurance coverage eligibility
- Interviewed claimants and corresponded with agents to ascertain facts of accident in order to reach a conclusion regarding liability and investigated questionable claims
- Analyzed insurance claims to determine extent of insurance carrier's liability and settled claims with claimants in accordance with policy provisions
- Maintained comprehensive electronic working papers to support and substantiate examination findings and conclusions
- Utilized excellent interpersonal skills to assist clients from diverse cultural and socio-economic backgrounds identify their insurance claim need and solve claim problems
- Utilized interview skills in order to assess client needs
- Utilized organizational skills and provided attention to detail to solve client problems.
External Financial Auditor
MH MILES COMPANY
01.2010 - 12.2011
- Performed financial audits, compliance audits, operational audits, and Sarbanes Oxley (SOX) audits
- Developed specific audit plans - draft work programs, risk assessments, testing strategies, data requests, etc
- Performed test work and completed audit wrap up
- Drafted audit reports - write up observations and other sections of the audit report and presented to management
- Proactively identified, assessed, summarized and communicated internal control gaps to management
- Experience working with nonprofit organizations, community groups and/or government programs
- Utilized interviewing skills in order to perform client audits
Senior Internal Auditor
ARRIS
01.2006 - 12.2009
- Executed risk-based internal audit programs
- Assisted management in updating current process documentation and actively partnered with management to ensure effective controls are in place to address key business and financial reporting risk
- Prepared work papers documenting procedures performed and that fully support audit findings
- Recommended improvements to control deficiencies
- Prepared Internal Audit reports which include formal recommendations to management for review and implementation
- Tracked and followed up on audit findings for remediation
- Lead walkthroughs, design test steps and perform testing procedures on SOX financial controls documenting testing results
- Reviewed and reported to IA management on the effectiveness of the issue remediation and/or implementation of recommendations.
Risk and Control Analyst
FEDERAL HOME LOAN BANK
01.2004 - 12.2006
- Executed risk-based internal audit programs
- Assisted management in updating current process documentation and actively partnered with management to ensure effective controls are in place to address key business and financial reporting risk
- Prepared work papers documenting procedures performed and that fully support audit findings
- Recommended improvements to control deficiencies
- Prepared Internal Audit reports which include formal recommendations to management for review and implementation
- Tracked and followed up on audit findings for remediation
- Lead walkthroughs, design test steps and perform testing procedures on SOX financial controls documenting testing results
- Reviewed and reported to IA management on the effectiveness of the issue remediation and/or implementation of recommendations.
Senior Internal Auditor
CANADA LIFE
01.2002 - 12.2004
- Directed highly demanding financial, operational and compliance audits for individual life, group life, individual annuities, group annuities, long-term and short-term disability, variable annuities, fixed annuities, compliance, anti-fraud program and anti-terrorism program departments.
Senior Internal Auditor
SUNTRUST BANK
01.1999 - 12.2001
- Directed and/or performed highly demanding financial, operational, and compliance audits for retail banking, commercial banking, trustee assets, fixed assets, derivatives, repurchase agreement accounting, corporate accounting, deposit accounting, compliance, internal control, automated teller data encryption security, and network disaster recovery of various sizes.
Education
MBA -
KELLER GRADUATE SCHOOL OF MANAGEMENT
01.2001
ASSOCIATE ARTS degree in ACCOUNTING -
PRINCE GEORGES COMMUNITY COLLEGE
01.1999
BACHELOR OF SCIENCE -
WASHINGTON ADVENTIST UNIVERSITY
01.1988
Skills
- Internal Audit
- SOX
- CPA
- CIA
- GAAP
- Accounting
- General Ledger Accounting
- Bank Reconciliation
- Account Reconciliation
- Journal Entries
- Auditing
- Claims
- Claims analysis
- Interpersonal and written communication
- Policy Interpretation
Certification
- Certified Public Accountant (CPA)
- Certified Internal Auditor (CIA)
Timeline
Claims Analyst
Jacobson Online
09.2022 - 07.2023
Provider Customer Service Representative
Hornet Staffing (Tricare)
06.2022 - 02.2023
Claims Representative
Jacobsons Insurance Talent
08.2021 - 08.2021
Internal Auditor
BLUE CROSS AND BLUE SHIELD ASSOCIATION
01.2015 - 12.2019
Claims Examiner
GEICO INSURANCE COMPANY
01.2011 - 12.2013
External Financial Auditor
MH MILES COMPANY
01.2010 - 12.2011
Senior Internal Auditor
ARRIS
01.2006 - 12.2009
Risk and Control Analyst
FEDERAL HOME LOAN BANK
01.2004 - 12.2006
Senior Internal Auditor
CANADA LIFE
01.2002 - 12.2004
Senior Internal Auditor
SUNTRUST BANK
01.1999 - 12.2001
MBA -
KELLER GRADUATE SCHOOL OF MANAGEMENT
ASSOCIATE ARTS degree in ACCOUNTING -
PRINCE GEORGES COMMUNITY COLLEGE
BACHELOR OF SCIENCE -
WASHINGTON ADVENTIST UNIVERSITY
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