Summary
Overview
Work History
Education
Skills
Accomplishments
Honors Accomplishments
Timeline
Generic

Brittani Pinelle

Taylorsville

Summary

  • Experienced with thorough investigation and assessment of insurance claims.
  • Utilizes critical thinking and detailed analysis to ensure fair and timely settlements.
  • Track record of strong understanding of regulatory compliance and effective communication with stakeholders.

Overview

10
10
years of professional experience

Work History

HBS-Assoc Claims Processor/HBS- Assoc Claims Examiner

SelectHealth Insurance
06.2021 - Current
  • Passed off and proficient in all claim’s examiner specialty queues including High Dollar claims
  • Skilled with Microsoft applications and data entry on Excel spreadsheets
  • Trained as a claim liaison working to help communication between departments within SelectHealth
  • Examines high dollar and high interest claims to ensure that they were processed correctly
  • Collaborates with other departments to maintain the proper Medicare and Government programs claim processing guidelines
  • Meets productivity requirements monthly
  • Acts as a mentor to teammates
  • Coaches and develops others and provides effective feedback
  • Accurate and meticulous when processing claims, demonstrated by high audit scores
  • Provides superior customer service that is consistent with policies, company values and quality standards
  • Maintains the confidentiality of member's personal information to be compliant with internal confidentiality policy
  • Exhibits leadership skills by modeling work ethic, positive attitude, dress code, attendance, communication, and interactions with peers
  • Stays current and conversant on general plan design and modifications to process with accuracy
  • Passed off and proficient in all claim’s processor specialty and general queues
  • Provides guidance to and answers more complex questions for less experienced claim processors/examiners

Health Benefit Specialist

SelectHealth Insurance
09.2018 - 06.2021
  • Receives incoming calls from members, providers, facilities, employer groups, and other departments
  • Resolves customer's issues on the initial call or provides timely follow-up when additional research is required
  • Proficient is typing and 10-key
  • Gives claim explanations to callers daily
  • Experienced in claim interpretation and has a basic understanding of processing guidelines
  • Complies with established criteria for response time, handling time, availability, and call flow
  • Complies with established auditing criteria
  • Educates callers on correct use of their plans, including coverage of benefits, utilization, and administrative guidelines, in collaboration with teammates and other departments

GM Assistant Team Lead/Bookkeeping and Accounting

Smith’s Food & Drug
08.2015 - 09.2021
  • Assistant Manager of a GM team of 6 people which includes stocking shelves and ordering product
  • Helped managing and reconciling finances and daily books
  • Proficient in 10-key and accounting software

Education

High School Diploma -

Brighton High School
Cottonwood Heights, UT
01-2010

Skills

  • Claims processing
  • Verbal communication
  • Data verification
  • Medicare claims process
  • Microsoft Office Suite
  • Automated work distributor (AWD)
  • Policy interpretation
  • Investigative skills
  • Records review
  • Coding systems
  • Claims investigation
  • Coverage determination

Accomplishments

  • Used Microsoft Excel to develop itemized split tracking spreadsheets.
  • Helped plan and present trainings, mentored and coached peers, and provided help to ensure projects were met on time.
  • Developed and executed an engagement plan for our team to help boost morale during busy call times.
  • Helped with replying to Secure Emails by conveying difficult information in a way that is easy to understand for our members.

Honors Accomplishments

  • On Deck Program at SelectHealth, Selected by management to be in the program because of my ability to exceed expectations.
  • I helped plan and present trainings, mentored and coached peers, and provided help to ensure projects were met on time.
  • I worked on Claims Questions to help resolve claims issues or mentor peers on proper processing guidelines.
  • Met Member Services expectations for follow up work while maintaining the second highest follow up average on the team.
  • Received praise from my supervisor and manager due to number of compliment calls I receive.

Timeline

HBS-Assoc Claims Processor/HBS- Assoc Claims Examiner

SelectHealth Insurance
06.2021 - Current

Health Benefit Specialist

SelectHealth Insurance
09.2018 - 06.2021

GM Assistant Team Lead/Bookkeeping and Accounting

Smith’s Food & Drug
08.2015 - 09.2021

High School Diploma -

Brighton High School

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Brittani Pinelle