Caroline Gromak
Raleigh,NC
Summary
Highly organized and detail-oriented professional with solid expertise in managing all aspects of claims operations with keen focus on identifying trends, mitigating risks, and implementing effective strategies. Adept at investigating insurance claims, conducting inspections, and assessments for accurate payouts. Capable of identifying exposures, recommending solutions, and implementing approved programs to promote loss prevention and ensure compliance. Proficient in processing client requests, offering comprehensive service and product education, and fostering revenue generation. Strong aptitude for identifying discrepancies within claims and engaging with providers to secure essential information.
Overview
15
15
years of professional experience
Work History
Inventory Specialist
Sidecar Health
Covina, CA
01.2022 - Current
- Improved processing efficiency 15% over the last quarter
- Manage allocation of more than 2K claims daily to the appropriate processors
- Conduct training for new and existing claims processors
- Organize weekly misstatement meetings in collaboration with department heads
- Implement a robust process for transferring deductible credits
- Track claims and denials throughout complete lifecycle
- Assist members in resolving problems related to claims and eligibility
- Recognize discrepancies in claims and communicating with members to obtain necessary information
- Reached processing of all misstatement or denied claims within 10-day timeframe
- Attained 100% accuracy rate in domain of claims processing
- Identified numerous deficiencies in existing claims processing Standard Operating Procedures (SOPs) by enhancing operational efficiency across the claims division
National Account Administrator
SASR
Raleigh, NC
01.2021 - 01.2022
- Administered project and job requests by ensuring alignment with strategic plan for addition, modification, cancellation, or deletion of requests
- Liaised with designated associates and essential stakeholders by delivering comprehensive reports on substantial project and job alterations
- Formulated comprehensive daily reports summarizing actual and projected staffing, catering to clients and internal stakeholders
- Identified and scheduled directorial recruitment and continuity positions in partnership with Field Management
- Manage client timesheets, encompassing review and endorsement
- Attained over 50% increase in Gross Profit Margin for the most recent client
- Sustained Gross Profit Margin of over 30% for all clients consistently
- Processed more than 1K timesheets weekly with precision and efficiency
- Executed thorough audits to minimize profit depletion from travel expenditures
Accountant
Harris Teeter
Raleigh, NC
01.2010 - 01.2021
- Orchestrated supervision and maintenance of daily operations and duties for Customer Service team by guaranteeing fulfillment of services to meet customer contentment and within allocated timeframes
- Oversaw both incoming and outgoing customer service calls
- Guided procedures for account reconciliation and generated necessary accompanying records
- Harmonized all accounting operations with internal guidelines and pertinent regulatory conformity prerequisites
- Obtained and sustained a perfect score of 100% in Loss Prevention Auditing with an impressive performance of 97% in all Anti-Money Laundering Audits
- Devoted to delivering exceptional customer service by engaging in education of clients regarding a diverse spectrum of company products and services
- Earned an outstanding customer satisfaction score of 95% by highlighting a steadfast dedication to delivering unparalleled services
Education
Bachelor’s Degree - Psychology
Fayetteville State University
Fayetteville, NCSkills
- Account Management
- Risk Assessment & Execution
- Reporting & Documentation
- Insurance Claims Management
- Regulatory Compliance
- Complex Problem Resolution
- Strong Interpersonal Skills
Volunteer Experience
Beta Tester, Wurk Now, Raleigh, NC
Timeline
Inventory Specialist
Sidecar Health
01.2022 - Current
National Account Administrator
SASR
01.2021 - 01.2022
Accountant
Harris Teeter
01.2010 - 01.2021
Bachelor’s Degree - Psychology
Fayetteville State University