Christine Knop
Ellinwood,KS
Summary
Proficient claims associate skilled in handling high volumes of claims. Processes adjustments based on identifiable liability and compensability. Supports work of senior team members by organizing documentation and assisting on complex cases.
Overview
21
21
years of professional experience
Work History
Insurance Claims Specialist
Benefit Management LLC
Great Bend , KS
2004.01 - 2024.10
- Negotiated settlements between claimants and insurers when necessary to resolve disputes quickly.
- Reviewed customer insurance claims to ensure accuracy and completeness of information.
- Calculated benefit payments based on policy terms, coverage limits, and applicable regulations.
- Assisted customers in filing new insurance claims and provided status updates on existing ones.
- Maintained detailed records of all claim activities including correspondence, decisions, payments.
- Investigated suspicious or fraudulent claims and reported findings to management.
- Coordinated with external parties such as lawyers, surveyors, appraisers during investigations.
- Prepared reports summarizing claim activity for senior management review.
- Reviewed denied claims for errors or omissions before finalizing decision notices.
- Processed requests for additional documentation from customers in a timely manner.
- Resolved customer complaints related to insurance claim processing.
- Provided guidance to customers regarding their rights and obligations under the insurance policies.
- Collaborated with team members to identify trends in customer issues and develop solutions accordingly.
- Analyzed claim records, policy provisions, and other relevant documents to determine validity of claims.
- Adjusted and claims under close supervision of more experienced claims team members.
- Supported efficient handling of complex claims and followed up on open, denied, or suspended claims to complete required line items.
- Monitored reports to identify claims issues and worked with adjusters to resolve problems.
- Collaborated with fellow team members to manage large volume of claims.
- Served as subject matter expert for non-standard coverage questions, property damage, and collision.
- Assisted claimants, providers and clients with problems or questions regarding claims.
Senior Configuration Analyst
ValueHealth Benefit Administrators
Great Bend , KS
2004.01 - 2024.08
- Performed system testing for all EDI transactions prior to implementation.
- Configured third-party software applications used in conjunction with EDI processing activities.
- Conducted reviews of posted electronic medical data for other teams within the company.
- Provided technical support and training to staff on EDI systems, processes and procedures.
- Maintained existing maps in various translation software packages.
- Coordinated with external vendors to ensure timely delivery of required documents and services.
- Conducted regular meetings with key stakeholders to review project progress and discuss possible improvements.
- Issued notices of violation when required by law or regulation.
- Determined whether proposed modifications meet minimum standards set forth by local ordinances.
- Assisted customers with inquiries about health insurance policies and coverage options.
- Identified areas where improvements could be made in terms of customer service delivery.
- Performed administrative tasks such as filing documents, updating databases, and preparing correspondence.
- Developed strategies to increase customer satisfaction ratings through improved service delivery processes.
- Resolved customer complaints or escalated them as necessary in a timely manner.
- Participated in team meetings and provided input on ways to improve operational efficiency.
- Answered phone calls promptly and responded to emails within 24 hours.
- Prepared reports on customer feedback data for management review.
- Processed changes in insurance policies and periodically reassessed client needs.
125 Plan Team Lead
Benefit Managment LLC
Great Bend , KS
2006.08 - 2014.08
- Coordinated team resources to achieve project goals.
- Identified opportunities for process improvements, implementing changes when required.
- Trained new staff in relevant processes and procedures.
- Ensured compliance with company policies and procedures throughout the team.
- Delegated tasks appropriately according to individual skill sets.
- Resolved escalated customer complaints or queries promptly and efficiently.
- Conducted performance appraisals for team members, providing feedback and identifying areas of improvement.
- Monitored team performance against targets, taking corrective action where necessary.
- Provided leadership and guidance to team members, ensuring that tasks were completed on time and to a high standard.
- Collaborated with other departments to develop effective solutions that meet customer needs.
- Assisted the manager in setting achievable goals for the team while monitoring progress towards them.
- Provided support to junior staff during peak periods of workloads.
- Supported the manager in developing plans for future projects, initiatives and objectives.
- Held regular one-on-one coaching sessions with staff members to encourage personal development.
- Developed strategies to increase team productivity and improve customer service levels.
- Monitored team progress and enforced deadlines.
- Collaborated with management team to implement new work procedures or policies.
- Motivated and empowered team members to build customer satisfaction and loyalty to support retention and growth.
- Resolved customer complaints and issues promptly, ensuring high levels of satisfaction.
- Championed the adoption of new technologies to improve team productivity and service delivery.
- Conducted regular performance evaluations, providing constructive feedback and personalized coaching.
- Collaborated with other departments to streamline processes and improve interdepartmental cooperation.
- Displayed strong telephone etiquette, effectively handling difficult calls.
- Identified needs of customers promptly and efficiently.
- Monitored operations and reviewed records and metrics to understand company performance.
- Identified root cause of technical issues and developed solutions.
- Researched, analyzed and diagnosed complex system problems.
- Ensured prompt resolution of customers' inquiries via phone, email or chat support channels.
- Reviewed customer feedback and complaints to identify areas of improvement in customer service processes.
- Performed quality assurance checks on calls handled by agents in order to maintain high levels of accuracy in responses provided by agents.
- Managed the development of a comprehensive knowledge base used by team members when responding to customers' queries.
- Analyzed call center data to identify trends in customer issues and recommend solutions accordingly.
- Developed and implemented strategies for providing excellent customer service experience.
- Drafted scripts for agents handling incoming calls so that they can respond accurately and effectively.
- Developed policies and procedures related to customer service operations.
- Served as point-of-contact between customers and internal teams regarding escalated issues requiring special attention.
- Monitored staff performance to ensure adherence to customer service standards.
- Provided exceptional customer service to ensure customer satisfaction.
- Evaluated employee job performance and motivated staff to improve productivity.
- Monitored phone calls to provide feedback and coaching.
- Organized shift assignments to meet expected coverage demands by factoring in typical loads and upcoming changes.
Education
Bachelor of Arts - Accounting
Western State Colorado University
Gunnison, CO1996-05
Skills
- Claims Investigation
- Insurance knowledge
- Troubleshooting
- Claim Amount Calculations
- Customer Service
- EDI Setup and Integration
- New Vendor Implementation
Affiliations
- Golfing
- Quilting
- Travel
Timeline
125 Plan Team Lead
Benefit Managment LLC
2006.08 - 2014.08
Insurance Claims Specialist
Benefit Management LLC
2004.01 - 2024.10
Senior Configuration Analyst
ValueHealth Benefit Administrators
2004.01 - 2024.08
Bachelor of Arts - Accounting
Western State Colorado University
Similar Profiles
Erick AlexanderErick Alexander
Member/Provider Service Representative at Value Health Benefit Management LLCMember/Provider Service Representative at Value Health Benefit Management LLC
Renee CollinsRenee Collins
Member Service Representative at Superior Vision Benefit ManagementMember Service Representative at Superior Vision Benefit Management
Lauren SmithLauren Smith
Account Manager at Benefit ManagementAccount Manager at Benefit Management