Brittany Delay
Middleton
Summary
Dynamic Team Lead at Imagine360 with expertise in project management and quality assurance. Proven track record in enhancing claims processing efficiency and fostering cross-department collaboration. Adept at training and developing team members while driving performance improvements. Recognized for solving complex problems and delivering actionable insights to senior leadership.
Overview
21
21
years of professional experience
Work History
Team Lead, Medical Claims Administrator
Imagine360
10.2024 - Current
- Responsible for the cascading of information immediately to teams, leading team huddles, and supporting the onboarding and training of new team members.
- Responsible for the timely and accurate entry of claims data.
- Perform project management for data entry and analysis projects.
- Solve complex problems, and present solutions to senior leaders.
- Lead special projects and other duties assigned by leadership.
- Make recommendations to business processes to gain efficiencies and enhance performance related to data.
- Compiles stop-loss claim submissions and notices, then enters them in the claims system.
- Ensures all claim information is included in the submission, and follows up with the third-party administrator when necessary.
- Compile periodic reports for various stakeholders.
- Recognizes, documents, and alerts the appropriate supervisor of trends.
- Performs self-quality monitoring in order to develop and execute plans to meet established goals.
- Provides ongoing feedback to help optimize quality performance for the department.
- Collaborates cross-departmentally to improve or streamline procedures.
Medical Claims Administrator
Imagine360
02.2024 - 10.2024
- Compiles stop-loss claim submissions and notices, and enters them in the claims system.
- Ensures all claim information is included in the submission, and follows up with the third-party administrator when necessary.
- Properly document the claim file.
- Compile periodic reports for various stakeholders.
- Review claims for appropriateness.
- Recognizes, documents, and alerts the appropriate supervisor of trends.
- Performs self-quality monitoring in order to develop and execute plans to meet established goals
- Provides ongoing feedback to help optimize quality performance
- Collaborates cross-departmentally to improve or streamline procedures.
- Develops new or improves current internal processes to enhance quality.
Document Support Specialist
12.2020 - 02.2024
- Maintains the internal and external facing document platforms and files
- Completes audit and research projects
- Drafting and updating processes and tracking documents
- Assisting Document Specialists with updating Summaries of Benefits and Coverage (SBCs) Amendments, and Plan Documents
- Researches Plan Documents and historical benefit decisions
- Developed a basic understanding of regulations and the unique ways different medical benefits interact with each other and their potential downstream impact
- Have excellent record keeping of all assigned tasks to ensure a detailed and accurate record is kept for the future research needs
- Performs other duties as assigned to ensure individual and group goals are achieved with accuracy, customer service, and timely turnaround
Blue Card Specialist II
01.2018 - 12.2020
- The liaison between Blue Cross/Blue Shield Networks and its current and potential clients
- Run daily reports for claim inventory
- Communicate with the claims department and work together to make sure claims are correct
- Track medical claims to ensure they meet the Blue Cross/Blue Shield guidelines
- Communicate with the Blue Cross/Blue Shield networks concerning escalated issues and resolving them in a timely manner
- Identify customer and provider needs, clarify information, research issues and provide solutions and/or alternatives in a timely manner.
Paraprofessional
Menifee Union School District
03.2004 - 10.2016
- Met regularly with parents and guardians to discuss children's progress.
- Worked with other teachers and administrators to evaluate and revise elementary school programs.
- Developed students' computer and technology skills through demonstrations and practice.
- Encouraged interactive learning by incorporating educational software and the Internet.
- Cooperated with parents to support students' learning and healthy development in school and at home.
- Created a classroom environment in which children could learn respect for themselves and others.
Education
High School Diploma -
Legacy Christian School
Alta Loma, CA01.2003
Skills
- Quality assurance
- Change management
- Project management
- Claims processing
- Cross-department collaboration
- Team leadership
- Employee training
- Attention to detail
- Verbal and written communication
- Goal setting
Timeline
Team Lead, Medical Claims Administrator
Imagine360
10.2024 - Current
Medical Claims Administrator
Imagine360
02.2024 - 10.2024
Document Support Specialist
12.2020 - 02.2024
Blue Card Specialist II
01.2018 - 12.2020
Paraprofessional
Menifee Union School District
03.2004 - 10.2016
High School Diploma -
Legacy Christian School
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