BRITTANY RIDDICK
Virginia Beach,VA
Summary
To find a job in the related field in which prior experience in. To utilize the skills to succeed in the field in which I am applying for. Have the ability to execute programs using limited resources. Problem solving, analytical, leadership and communication skills are some of the qualities developed from prior experience.
Overview
9
9
years of professional experience
Work History
Claim
Health Plans Inc. (HPI)
Remote
08.2024 - Current
- Learning activities/tasks associated with his/her role.
- Works under direct supervision.
- Relies on others for instruction, guidance, and direction.
- Work is reviewed for technical accuracy and soundness.
- Codes and processes claims forms for payment ensuring all information is supplied before eligible payments are made.
- Researches and analyzes claims issues
- Good oral and written communication skills; previous experience using PC, database system, and related software(word processing, spreadsheets, etc.).
- Able to handle more complex claims.
- Good understanding of the application of benefit contracts, pricing, processing, policies, procedures, gov'tregulations, coordination of benefits, & healthcare terminology.
- Good working knowledge of claims and products
- Excellent knowledge of various operations of organization, products, and services.
- Reviews, analyzes and processes claims/policies related to events to determine extent of company's liability andentitlement.
- Researches and analyzes claims
- Review and Process DME claims
- Review and process Subrogation claims
- Review and process Adjustment claims
- Review and process Member reimbursements
- Analyze benefit codes and cpt code
Claim Analyst
United Healthgroup (The judge group)
05.2023 - 03.2024
- Learning activities/tasks associated with his/her role. Works under direct supervision.
- Relies on others for instruction, guidance, and direction.
- Researches and analyzes claims issues Good oral and written communication skills; previous experience using PC, database system, and related software (word processing, spreadsheets, etc.).
- Work is reviewed for technical accuracy and soundness. Codes and processes claims forms for payment ensuring all information is supplied before eligible payments are made.
- Identified insurance coverage limitations with thorough examinations of claims documentation and related records.
- Analyzed information gathered by investigation and report findings and recommendations.
- Process DME and Outpatient claims
Claims Representative I
Anthem
07.2019 - 07.2022
- Learning activities/tasks associated with his/her role. Works under direct supervision.
- Relies on others for instruction, guidance, and direction.
- Work is reviewed for technical accuracy and soundness. Codes and processes claims forms for payment ensuring all information is supplied before eligible payments are made.
- Researches and analyzes claims issues Good oral and written communication skills; previous experience using PC, database system, and related software (word processing, spreadsheets, etc.).
- Able to handle more complex claims.
- Good understanding of the application of benefit contracts, pricing, processing, policies, procedures, gov't regulations, coordination of benefits, & healthcare terminology.
- Good working knowledge of claims and products Excellent knowledge of various operations of organization, products, and services.
- Reviews, analyzes and processes claims/policies related to events to determine extent of company's liability and entitlement.
- Researches and analyzes claims issues Helped with Core Claims Helped with Medicare Claims Used Facets to process claims.
Health Program Rep I
Anthem
Norfolk, VA
08.2018 - 12.2018
- Management programs and specific identified members Gathers and records appropriate member information in accordance with policies and procedures via telephone.
- Encourages members to participate in Care Management programs by providing information about program, outlining program features/value and explaining available services.
- Records call details and utilize call scripts as needed based on client requirements.
- Directs member inquiries to appropriate clinical staff. Initiates referrals and manages consults from clinicians for participants registered in Care Management.
- Gathers information from hospitals, health plans, physicians, patients, vendors and other referral sources. Contacts physician offices to obtain demographic information or related data as needed.
Benefit Administration Specialist
Conduent
Chesapeake, VA
09.2016 - 05.2018
- Responsible for day-to-day service and administration of benefit plans for assigned clients using established procedures and detailed instructions.
- Improves participant decision-making process by having a complete knowledge of the clients health and welfare employee benefit plans including but not limited to medical, dental, prescription plan, life insurance, AD&D, and LTD enrollments and changes; COBRA process, as well as the cost of associated premiums explains appropriate participant forms and provides guidance on completion.
- Assists participants with portal navigation
Education
High School Diploma - undefined
I.C Norcom High School
06.2013
Skills
- Microsoft Word
- Avaya phone system
- Ten Key Calculations
- Switch Board
- Right fax
- Claims work station
- Microsoft Outlook
- WPM:40
- Member 360
- Macess
- WFH
- Facets
- Medical Terminology
- Nice (Claim system)
- Prod (Claim system)
- Imaging
- Claim processing
- Microsoft teams
- Omega
- Communication skills
- Customer service
- Microsoft excel
- Documentation review
- Javelina
- Imagining tool
- Subrogation claims
- DME
- Member Reimbursement
- Medicare
- Adjustments
- Microsoft team
- Medwatch
- Summary plan document
- Coding
Timeline
Claim
Health Plans Inc. (HPI)
08.2024 - Current
Claim Analyst
United Healthgroup (The judge group)
05.2023 - 03.2024
Claims Representative I
Anthem
07.2019 - 07.2022
Health Program Rep I
Anthem
08.2018 - 12.2018
Benefit Administration Specialist
Conduent
09.2016 - 05.2018
High School Diploma - undefined
I.C Norcom High School