CHANELE BURR
Moreno Valley,USA
Summary
Claims processing professional with expertise in managing complex inquiries and ensuring adherence to industry standards. Proven ability to solve problems effectively while processing high volumes of claims efficiently. Committed to utilizing research and communication skills to improve customer experiences and contribute to team success.
Overview
7
7
years of professional experience
Work History
Claim Representative
Cigna Group
03.2024 - Current
- Ensured compliance with industry standards by adjusting and completing claims using ICD/10, CPT, and HCPC codes, achieving an accuracy rate of 95% and completing 70 claims within deadlines.
- Processed 80+ claims daily while adhering to policies and regulations, consistently meeting deadlines and contributing to streamlined processing times.
- Processed professional medical claims while adhering to policies and procedures, following California state laws and regulations of surrounding states to ensure compliance.
- Resolved complex medical, dental, flex spending, and pharmacy claims through thorough research on surgery and medical necessity, collaborating with billing and customer support teams to resolve customer concerns and escalate unresolved matters.
- Addressed complex high-value claims by referring intricate situations to appropriate departments or leadership for further resolution, showcasing effective problem-solving abilities.
Plan Advisor
UMR (3rd Party Administrator for United Healthcare)
09.2023 - 03.2024
- Resolved inquiries on eligibility, claims, and financial spending accounts, improving customer satisfaction and retention.
- Researched complex medical, dental, flex spending, and pharmacy claims using multiple databases, collaborating with support resources to resolve customer issues.
- Adjusted and completed claims using ICD-10, CPT, and HCPC codes.
- Managed complex issues, escalating to relevant departments for timely resolution and minimizing customer impact.
Lead Fraud Investigator
Genesis Financial Solutions
Ohio
02.2019 - 06.2023
- Examined financial statements, written documents, and audio files to gather evidence for fraud cases.
- Reviewed and researched evidence/documents to analyze patterns and claims for identity theft and unauthorized use; collected and validated documentation from merchants and consumers to ensure accuracy and integrity in resolution.
- Conducted client interviews to gather information for fraud claims; assisted customers in completing affidavits and applications to ensure accurate submissions.
- Facilitated group discussions with team members to develop strategies for combating fraud, improving collaborative response tactics.
- Processed over 40 claims daily to ensure timely assistance for clients. to assist clients efficiently.
- Trained new investigators during onboarding, ensuring adherence to policies and procedures.
Education
Master's - Business Administration
Herzing University
Madison, WI05-2016
BBA - Business Administration And Management
Herzing University
Madison, WI10-2011
Skills
- Fraud analysis
- Claims research
- Claim assessment
- Insurance claims review
- Claims documentation
- Microsoft Office Suite
- Problem solving
- Decision making
- Time management
- Team collaboration
- Effective communication
- Interpersonal skills
Accomplishments
Used Microsoft Excel to develop inventory tracking spreadsheets.
Timeline
Claim Representative
Cigna Group
03.2024 - Current
Plan Advisor
UMR (3rd Party Administrator for United Healthcare)
09.2023 - 03.2024
Lead Fraud Investigator
Genesis Financial Solutions
02.2019 - 06.2023
Master's - Business Administration
Herzing University
BBA - Business Administration And Management
Herzing University