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Brianna Smith
Cypress,CA
Summary
Experienced with managing claims processes and leading teams to ensure efficient and accurate handling. Utilizes strong analytical skills and attention to detail to identify issues and implement effective solutions. Track record of fostering teamwork and maintaining high standards in claims management.
Overview
13
13
years of professional experience
Work History
Manual Claims Supervisor
OptumRx
10.2024 - Current
- Directed a team of 10 employees, fostering their growth into proficient processors. Coordinated with multiple departments to maintain compliance with CMS guidelines. Championed team development initiatives to elevate overall performance.
- Supervised daily operations of claims processing team, ensuring compliance with regulatory standards.
- Led training initiatives for new staff to enhance knowledge of claims systems and procedures.
Manual Claims Representative Senior
OptumRx
01.2024 - 10.2024
- Achieved efficient processing of 13 claims daily, contributing to team objectives through collaboration with A&G team on IDRS and ServiceNow documentation. Enhanced training for new hires by creating comprehensive CBMC training modules and effective learning worksheets.
Manual Claims Representative
OptumRx
08.2019 - 01.2024
- Processed 32.5 claims daily with an average of 99.9 percentage accuracy per CMS Guidelines.
- Analyzed claim discrepancies, identifying root causes and facilitating resolutions.
Technician
CVS Pharmacy
05.2017 - 08.2019
- I worked to help fill prescriptions along with data entry for prescriptions being dropped off. I would make calls to insurance companies and do prior authorizations when needed.
- Maintained inventory levels, ensuring accurate stock management.
- Trained new staff on operational procedures and customer service standards.
Technician
Walmart Pharmacy
03.2015 - 05.2017
- I would fill prescriptions and do a lot of prior authorizations for Medi-Cal patients. I would do Tars along with Prior authorization for CalOptima and LA Care. Assisted customers with medication inquiries and health consultations.
Service Clerk
Walgreens
03.2013 - 03.2015
- Assisted customers in store as a customer service employee. Supported pharmacy operations by filling prescriptions and processing insurance claims.
Education
Pharmacy Technician California State License -
PTCB
Bachelor of Science Degree - Business Administration with a Concentration in Healthcare Administration
Southern New Hampshire University
09-2022
Skills
- Claims management expertise
- Teamwork and collaboration
- Policy interpretation
- Claims auditing
- Team motivation
- Performance monitoring
Languages
English
Native or Bilingual
Interests
Creating worksheets, Learning new things, Helping others learn, Understanding others needs
Timeline
Manual Claims Supervisor
OptumRx
10.2024 - Current
Manual Claims Representative Senior
OptumRx
01.2024 - 10.2024
Manual Claims Representative
OptumRx
08.2019 - 01.2024
Technician
CVS Pharmacy
05.2017 - 08.2019
Technician
Walmart Pharmacy
03.2015 - 05.2017
Service Clerk
Walgreens
03.2013 - 03.2015
Pharmacy Technician California State License -
PTCB
Bachelor of Science Degree - Business Administration with a Concentration in Healthcare Administration
Southern New Hampshire University
CONTACT
- Bripiper123@yahoo.com
- Cell phone: (562) 745- 7926