Summary
Overview
Work History
Education
Skills
Timeline
Generic

Darlene Kelley

Lakewood,California

Summary

Looking for a position within the Claims Department where I can use my over 30 years of Claims experience. Along with my knowledge of handling and resolving complex claim issues.

Overview

49
49
years of professional experience

Work History

Supervisor Recovery/Claims Supervisor

United Healthcare/Optum
02.2019 - 05.2025
  • Oversaw inventory and distribute work to examiners to insure claims processed timely.
  • Improved customer satisfaction with timely response to inquiries, addressing concerns, and finding effective solutions.
  • Conducted performance evaluations for staff members, identifying areas of improvement and guiding professional development plans. Also, provided coaching to address inefficiencies.
  • Reviewed claims with prompt and courteous resolution of inquiries and complaints from DMHC / CMS.
  • At times, audited new hire examiners for accuracy and feedback.
  • Enhanced communication within the team by holding regular meetings and encouraging open dialogue among all members.

Claims Lead/SME Team Leader

United Healthcare/Pacificare of California
02.1996 - 02.2019
  • Oversaw examiners quality with feedback to the examiners. Also, handled examiner error disputes with the quality team.
  • Answered questions and processed escalations/exceptions from Appeals/Marketing/DMHC.
  • Trained MD/Splits class of new examiners, also individual examiners for specific claim types.

Claims Liaison

Family Health Plan (FHP)
02.1994 - 02.1996


  • Reviewed and processed claims escalations / exceptions from other departments i.e. Marketing, Appeals, Contracting. Answered claims questions for detail on how the claim was processed.
  • Replied to Providers for claims status and inquires.


Claims Examiner

Family Health Plan (FHP)
09.1990 - 02.1994
  • Processed Medical Claims.

Claims Examiner

Prudential Insurance Company
05.1980 - 09.1988
  • Processed Dental claims for a couple years, then trained and processed Medical claims.

Clerk/Typist

Prudential Insurance Company
06.1976 - 05.1980
  • Filed and pulled claims files for examiners to process claims.
  • Answered phone calls.
  • Typed checks for claims payments.

Education

No Degree - Business

Long Beach City College
Long Beach, CA
09-1975

General Studies

Lakewood High School
Lakewood, CA
06-1974

Skills

  • Attention to detail
  • Coaching and mentoring
  • Analytical thinking

Timeline

Supervisor Recovery/Claims Supervisor

United Healthcare/Optum
02.2019 - 05.2025

Claims Lead/SME Team Leader

United Healthcare/Pacificare of California
02.1996 - 02.2019

Claims Liaison

Family Health Plan (FHP)
02.1994 - 02.1996

Claims Examiner

Family Health Plan (FHP)
09.1990 - 02.1994

Claims Examiner

Prudential Insurance Company
05.1980 - 09.1988

Clerk/Typist

Prudential Insurance Company
06.1976 - 05.1980

No Degree - Business

Long Beach City College

General Studies

Lakewood High School

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Darlene Kelley