Celia Crumel
Newark,DE
Summary
Dynamic and results-driven professional with extensive experience at AmeriHealth Caritas, excelling in claims evaluation and process improvement. Proven ability in settlement negotiation and active listening, achieving significant reductions in claim turnaround time while enhancing client satisfaction through effective communication and documentation review.
Overview
7
7
years of professional experience
Work History
Provider Claims Representative
AmeriHealth Caritas
09.2013 - 03.2015
- Evaluated claim documentation to ensure compliance with regulatory requirements
- Communicated effectively with clients to resolve inquiries and provide updates on claim status
- Analyzed trends in claim submissions, identifying areas for process improvement
- Reduced turnaround time for claim settlements by prioritizing tasks and managing deadlines effectively.
- Maintained compliance with industry regulations by adhering to established procedures and guidelines in claims handling.
Auto Claims Processor
State Farm
10.2011 - 06.2013
- Processed auto claims efficiently, ensuring accuracy in documentation and compliance with company policies.
- Conducted thorough investigations of claims, gathering necessary information from clients, witnesses, and service providers.
- Negotiated appropriate settlements with claimants, keeping the company''s financial interests in mind at all times.
- Reviewed police reports thoroughly to confirm accuracy of information provided in relation to auto accidents.
Provider Services Representative
Aetna Health Insurance
06.2008 - 03.2010
- Enhanced customer satisfaction by efficiently resolving provider inquiries and concerns.
- Acted as a liaison between providers and company leadership, effectively communicating concerns and feedback to facilitate continuous improvement initiatives.
- Educated providers on billing procedures, coding guidelines, and reimbursement policies for optimal claim submissions.
- Developed highly empathetic client relationships and earned reputation for exceeding service standard goals.
Education
Bachelor of Science - Biomedical Science
University of Wisconsin, Milwaukee
Milwaukee, WI12-2025
Skills
- Microsoft office
- Insurance claims review
- Claims investigation
- Time management
- Documentation review
- Settlement negotiation
- Flexible schedule
- Claims processing
- Active listening
- Claims adjustment
Timeline
Provider Claims Representative
AmeriHealth Caritas
09.2013 - 03.2015
Auto Claims Processor
State Farm
10.2011 - 06.2013
Provider Services Representative
Aetna Health Insurance
06.2008 - 03.2010
Bachelor of Science - Biomedical Science
University of Wisconsin, Milwaukee
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