CHRISTOPHER HAMBERGER
Middletown
Summary
Results-driven inquiry analyst with a proven track record of achieving quality objectives and enhancing team performance. Expertise in case management and development of training materials that improve operational excellence. Strong leadership skills demonstrated through effective mentoring of team members.
Overview
18
18
years of professional experience
Work History
Veteran Inquiry Analyst
OptumServe
06.2022 - Current
- OptumServe Veteran Inquiry Analyst with the most experience handling Veteran sources inquiries.
- Have never missed quality goals while working Veteran inquiries.
- Developed work instructions and training materials to standardize procedures and enhance team performance.
- Share case commander duties on a bi-weekly basis, assigning work and evaluating incoming cases to ensure they meet the criteria of a Veteran Inquiry.
- Coordinated team meetings and managed agendas during manager's PTO, leading discussions and refining response letters for Veterans.
- Contributed to team development since inception by training new hires on processes to ensure efficiency.
Senior Appeals Representative
OptumServe
09.2020 - 06.2022
- Solely managed veteran-sourced appeals, ensuring comprehensive oversight and resolution.
- Met all quality goals and managed complex appeals for the team.
- Since taking over these appeals, we have made our two-day TAT set by the VA.
- Compiled daily lists of complex appeals, streamlining processing for timely resolutions.
- Work with multiple books of business each day to have claims processed correctly.
- Use multiple screens and software systems to analyze claim data to accurately determine the course of action for an appeal request.
- Each appeal requires proper documentation and letters sent to providers explaining what has been done with the appeal.
- Sent letters and filled out the documentation application MCSW with accurate claim information.
- Completed training on all denial work instructions for enhanced expertise.
- Recognized as the primary candidate for new training courses to develop skills.
- Provided assistance to teammates in absence of SMEs, fostering collaboration and support.
- OptumServe appeals analyst with detailed knowledge of how to handle medical and dental claims being appealed by providers and veterans.
Senior Claims Representative
United Healthcare
Kingston
06.2016 - 09.2020
- Have met and exceeded production and quality goals to attain this position.
- Acquired multiple specialty claim processing skills with the position.
- First pass Empire SME with detailed knowledge of the Empire specific standard operating procedures for claims handling.
- Proficient in the Empire specific tools and computer macros used for claim handling.
- Handled multiple reports for the team, supported new hire training through one-on-one coaching and analytical data to enhance their success.
- Updated team’s SME SharePoint regularly to ensure accurate information access. and answered questions within 48 hours.
- Submitted updates to SOPs or tools.
- Attended meetings with business partners to foster relationships and clarify claim benefits.
- Work with supervisors directly daily for any team issues.
Mail-room Team lead
Firstsource
Lake Katrine
04.2008 - 06.2016
- Led team of 15 in daily claims processing, ensuring adherence to customer standard operating procedures.
- Verified health insurance coverage for members using standard operating procedures for our customer.
- Reviewed and verified completeness of medical records, filing them in compliance with customer guidelines.
- Mailed appeal letters to health-care providers and members, addressing claim disputes based on submitted medical claims.
- Prepared predetermination claims which included photos or x-rays with the medical claims attached.
- Scanned documents into digital workflow for efficient processing. and organized forms, made photocopies, and filed records.
- Drove company van to pick up medical documents from post office and transported them to our facility for handling.
Education
general diploma -
Highland Jr.-Sr. High School
Highland, NY06-2002
criminal justice
Dutchess Community College
Poughkeepsie, NYSkills
- Claim appeal analysis proficiency
- Expert healthcare claim analyst
- Complex medical review expertise
- Claims auditing ability
- Empire first pass SME experience
- Advanced Excel functions
- Spreadsheet analysis proficiency
- Microsoft Office proficiency
- Webex and Teams proficiency
- Computer literacy
- Deadline-driven
- Attention to detail
- Organizational skills
- Team leadership
- Team building expertise
- Works well under pressure
- Reliable and self-motivated
- Goal orientation
- On-the-job training experience
- Professional demeanor
Timeline
Veteran Inquiry Analyst
OptumServe
06.2022 - Current
Senior Appeals Representative
OptumServe
09.2020 - 06.2022
Senior Claims Representative
United Healthcare
06.2016 - 09.2020
Mail-room Team lead
Firstsource
04.2008 - 06.2016
general diploma -
Highland Jr.-Sr. High School
criminal justice
Dutchess Community College