Dawn Murray
Blasdell,NY
Summary
Results-driven healthcare professional with a strong background in claims processing and provider service. Expertise in claims investigation, reimbursement analysis and policy interpretation. Strong understanding of claims lifecycle including provider inquiries, pended claims investigation, and claims adjustments. Known for analytical problem solving, attention to detail, and collaboration across departments to resolve complex claim issues.
Overview
16
16
years of professional experience
Work History
BlueCard Claims Adjustor
Highmark BCBS
02.2026 - Current
- Perform adjustments on BlueCard claims between Home and Host plans
- Investigate claim discrepancies and reimbursement issues
- Ensure corrections comply with BlueCard program guidelines
- Analyze claim processing errors and coordinate resolution with internal teams
- Interpret insurance policies and reimbursement rules to determine correct payment
BlueCard Claims Processor
Highmark BCBS
08.2023 - 02.2026
- Process BlueCard claims requiring manual review and research
- Investigate pended claims verifying eligibility, coding accuracy, and billing information
- Apply BlueCard program policies to ensure correct adjudication
- Resolve claim discrepancies between Home and Host plans
- Collaborate with departments to correct claim processing issues
Provider Services Representative
Highmark BCBS
09.2021 - 08.2023
- Provided provider support regarding eligibility, benefits, and claims status
- Assisted providers with reimbursement questions and billing issues
- Researched complex claim inquiries and coordinated resolution
- Interpreted insurance policies and coverage guidelines
- Maintained high service standards in high-volume provider call environment
Patient Service Representative/Certified Medical Assistant
General Physicians PC
04.2010 - 02.2021
- Supported daily operations of a high-volume neurosurgery practice
- Coordinated surgical scheduling, insurance verification, and authorizations
- Managed patient intake, medical records, and documentation
- Trained new employees on office workflow and systems
- Served as Interim Office Manager overseeing staff coordination
- Assisted leadership in improving workflows and operational efficiency
- Participated in development of risk management plan
Education
Medical Assistant
Bryant & Stratton College
NYSkills
- Healthcare Claims Analysis
- Provider Relations
- Insurance Policy Interpretation
- Reimbursement Investigation
- Claims Research & Resolution
- Medical Billing & Coding Knowledge
- Healthcare Operations
- Workflow Improvement
- HIPAA Compliance
- Staff Training & Development
Timeline
BlueCard Claims Adjustor
Highmark BCBS
02.2026 - Current
BlueCard Claims Processor
Highmark BCBS
08.2023 - 02.2026
Provider Services Representative
Highmark BCBS
09.2021 - 08.2023
Patient Service Representative/Certified Medical Assistant
General Physicians PC
04.2010 - 02.2021
Medical Assistant
Bryant & Stratton College