Carol Fannin
Lee's Summit,MO
Summary
Dynamic claims professional with over 15 years of experience in claims processing and team leadership. Skilled in auditing high-dollar claims and resolving discrepancies, driving operational excellence through meticulous attention to detail and effective problem-solving.
I began working at FMH Benefit Services as a Customer Service Representative in November 1998. I held that position for 6 months and advanced to a Claims Analyst. I left FMH in May 2002 for 10 months, seeking better opportunities. I returned to FMH in March 2003 and worked until 2017. I have held the positions of Customer Service Representative, Claims Analyst, Auditor, and Team Lead. Team Lead for 10 plus years. I stopped working for a year in 2017 to help a friend with Leukemia. After he passed, I returned to CareSource in February 2018 and retired May 2022.
I was hired at FMH Benefit Services, a third-party administrator which was sold and renamed CoreSource, and then Trustmark. Currently, I think it has been sold again and is named Luminaire Health.
Overview
24
24
years of professional experience
Work History
Claims Specialist
Trustmark
Overland Park, Kansas
02.2018 - 05.2022
- Claim appeals: Research submitted information. If a medical review was required, information was forwarded via the queue to the nurses' team for review. Who, in turn, would consult with the doctors if necessary. If a claim was denied due to an error in processing, claims would be reviewed and processed, or a denial letter would be sent.
- Audited and released high-dollar claims up to $50,000.
- Claims adjustment projects: Usually, if a system error occurred and several claims were processed incorrectly, claims would be canceled, and the claims would be processed correctly.
- Reinsurance claims: Claims for a high-dollar member had to be paid by the end of the fiscal year. Claims were researched and processed within the time frame required.
- Plan Testing: With new groups and retained groups, claims with plan changes needed to be tested for accuracy in claim payment.
- Special projects for my supervisor.
Team Lead
Coresource
Overland Park, Kansas
03.2003 - 02.2017
- Held weekly meetings.
- Monitored Teams workflow.
- Led the team in daily operations and ensured work completion.
- Evaluated the yearly process of each team member, including their strengths and weaknesses.
- Claim appeals: Research submitted information. If a medical review was required, information was forwarded via the queue to the nurses' team for review. Who, in turn, would consult with the doctors if necessary. If a claim was denied due to an error in processing, claims would be reviewed and processed, or a denial letter would be sent.
- Audited and released high-dollar claims up to $75,000.00.
- Claims adjustment projects: Usually, if a system error occurred and several claims were processed incorrectly, claims would be canceled, and the claims would be processed correctly.
- Reinsurance claims: Claims for a high-dollar member had to be paid by the end of the fiscal year. Claims were researched and processed within the time frame required.
- Plan Testing: With new groups and retained groups, claims with plan changes needed to be tested for accuracy in claim payment.
- Special projects for my supervisor.
Biller
Headache and Pain Center
Overland Park, Kansas
05.2002 - 03.2003
- Processed patient billing and insurance claims.
- Managed patient accounts and resolved billing inquiries efficiently.
- Assisted patients in understanding their insurance benefits and payment options.
Claims Analyst
FMH Benefit Services
Overland Park, Kansas
11.1998 - 05.2002
- Analyzed claims data to identify trends and discrepancies.
- Reviewed documentation to ensure compliance with industry regulations.
- Daily production goals and quality percentages also had to be met.
Education
GED -
Raytown South
Raytown MOSkills
- Claims processing
- Appeals management
- Reinsurance claims
- Audit procedures
- Data analysis
- Regulatory compliance
- Team leadership
- Problem solving
- Attention to detail
- Time management
- Decision making
- Microsoft office
- Claims investigation
- Fraud detection
- Multi-tasking
- Teamwork
References
References available upon request.
Timeline
Claims Specialist
Trustmark
02.2018 - 05.2022
Team Lead
Coresource
03.2003 - 02.2017
Biller
Headache and Pain Center
05.2002 - 03.2003
Claims Analyst
FMH Benefit Services
11.1998 - 05.2002
GED -
Raytown South