CHANELE R. BURR
Moreno Valley,USA
Summary
Proactive and goal-oriented professional with excellent time management and problem-solving skills. Known for reliability and adaptability, with swift capacity to learn and apply new skills. Committed to leveraging these qualities to drive team success and contribute to organizational growth.
Overview
7
7
years of professional experience
Work History
Claim Representative
Cigna Group
US
03.2024 - Current
- Research complex issues and claims for medical, dental, flex spending and pharmacy, while using multiple databases and work with support resources to resolve customer issues and/or partner with others to resolve escalated issues.
- Adjust and complete claims using ICD/10 and CPT codes HCPC codes.
- Address complex issues with an awareness of when to refer complicated situations to various department or leadership for further assistance.
- Processing professional medical claims while adhering to the policies and procedures. Following California state laws amongst other surrounding states.
- Processing over 70 claims per day on average.
Plan Advisor
UMR (3rd Party Administrator for United Healthcare)
US
09.2023 - 03.2024
- Provide exceptional customer service while responding to and resolving customers service inquires and issues by identifying the topic and type of assistance needed, eligibility and claims, financial spending accounts and correspondence.
- Researched complex issues and claims for medical, dental, flex spending and pharmacy, while using multiple databases and work with support resources to resolve customer issues and/or partner with others to resolve escalated issues.
- Adjust and complete claims using ICD/10 and CPT codes HCPC codes.
- Address complex issues with an awareness of when to refer complicated situations to various department or leadership for further assistance.
Lead Fraud Investigator
Genesis Financial Solutions
Ohio
02.2019 - 06.2023
- Reviewing and researching evidence/ documents to analyze the overall patterns and claims for identity theft and unauthorized use claims. Receiving documentation from merchants and consumers on request then analyzing the data received. Determining a resolution while maintaining integrity and honesty.
- Provided training assistance with on-boarding new investigators. While adhering to policies and procedures closing each case in timely manner. Communication via chat, email or phone.
- Examined financial statements, written documents and audio files that could be used as evidence for fraud cases. Communicated with customers and company personnel, utilizing active listening and interpersonal skills.
- Participated in group discussions with team members to develop new ways to combat fraud. Conducted reviews of flagged transactions and reports that showed potential suspicious activity.
- Interviewed clients to gather information regarding their fraud claim. Helped customers fill out affidavit and application.
- Manged over 40 claims per day.
Education
Master’s - Business Administration
Herzing University
Madison, WI05-2016
BBA - Business Administration And Management
Herzing University
Madison, WI10-2011
Skills
- MS Office Suite
- Motivated Team Player
- Financial Fraud
- Claims investigation and research
- Effective communication
- Skilled problem solver
- Data Entry
- Personable
- Insurance claims review
- Time management
- Decision-making
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