CHANDRA CAREY
Alexander,AR
Summary
Professional claims analyst with proven track record in evaluating, processing, and resolving insurance claims. Strong focus on team collaboration and adaptability, ensuring seamless operations and optimal outcomes. Highly skilled in data analysis, risk assessment, and customer service, consistently delivering reliable and efficient results. Known for excellent problem-solving abilities and maintaining high standards in all tasks.
Overview
18
18
years of professional experience
Work History
Claims Analyst
Arkansas BlueCross & BlueShield
02.2021 - Current
- Process high volumes of medical claims accurately and efficiently under tight deadlines, ensuring prompt payment for services rendered.
- Research and resolved complex medical claims issues to support timely processing.
- Collaborate with healthcare providers to clarify billing discrepancies and negotiate payment terms.
- Support management''s decision-making process by providing insightful reports analyzing historical claims data.
- Conduct comprehensive audits to identify inconsistencies and irregularities in medical claims data.
- Maintain regulatory compliance by staying current with industry guidelines, state laws, and federal regulations.
- Negotiate with health care providers to reach mutually beneficial agreements on contested claim amounts.
- Provide exceptional customer service, addressing inquiries regarding coverage, benefits, and claim statuses promptly and professionally.
Prior Authorization Specialist
Arkansas Blue Cross and Blue Shield
05.2014 - 02.2021
- Collaborated with physicians to obtain necessary clinical information for prior authorization submissions.
- Maintained thorough knowledge of insurance plan requirements, facilitating accurate and timely completion of authorization forms.
- Analyzed medical records and other documents to determine approval of requests for authorization.
- Verified eligibility and compliance with authorization requirements for service providers.
- Collaborated with healthcare providers to ensure accurate billing and benefit coverage information.
- Maintained up-to-date knowledge on industry regulations, ensuring compliance throughout all benefit verification processes.
- Explained benefits to plan participants in easy to understand terms in order to educate each on available options.
Loss & Mitigation Specialist
Ally Financial
08.2006 - 04.2011
- Utilized dynamic negotiation skills and business acumen to successfully manage a multi-million dollar portfolio annually
- Interfaced with internal departments to expedite collection efforts and work collaboratively regarding workflow process
- Recognized for aggressively pursuing accounts through relationship-focused account management resulting in achieving record breaking sales and earning several Employee of the Month Awards and two consecutive Professionalism Awards
- Managed a high-volume caseload of at-risk borrowers, successfully negotiating mutually beneficial repayment solutions.
- Conducted comprehensive loan reviews, identifying opportunities for modifications and alternative repayment plans.
Education
Master of Business Administration - Business Administration
UNIVERSITY OF PHOENIX
University Of Phoenix12.2015
Bachelor of Science - Sports Management
UNIVERSITY OF TENNESSEE MARTIN
Martin, TN12.2005
Skills
- HIPAA Compliance
- Interpersonal and written communication
- Policy interpretation
- Decision-making
- Claims analysis
- Data interpretation
- Settlement negotiations
- Database management
Timeline
Claims Analyst
Arkansas BlueCross & BlueShield
02.2021 - Current
Prior Authorization Specialist
Arkansas Blue Cross and Blue Shield
05.2014 - 02.2021
Loss & Mitigation Specialist
Ally Financial
08.2006 - 04.2011
Bachelor of Science - Sports Management
UNIVERSITY OF TENNESSEE MARTIN
Master of Business Administration - Business Administration
UNIVERSITY OF PHOENIX
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