Microsoft Excel
Dawn Sims
Phoenix,AZ
Summary
Accomplished claims professional with a proven track record at Ebix Health Administration Exchange, Inc., excelling in claims administration, policy analysis and team leadership. Experienced with analyzing and processing claims efficiently and accurately.
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
35
35
years of professional experience
1
1
Certification
Work History
Claims Manager - International
Ebix Health Administration Exchange, Inc.
08.1997 - Current
- Managed a team of claims and customer service staff, providing coaching and performance feedback for improved accuracy and productivity.
- Implemented quality assurance measures, monitoring staff performance and providing constructive feedback for continuous improvement efforts.
- Conducted thorough investigations of complex claims, gathering evidence to support decision-making processes.
- Developed training materials to ensure consistent handling of claims and customer service across the department.
- Benefit plan review, implementation and program testing.
Medical Claims Analyst
John Alden Life Insurance
06.1989 - 04.1997
- Demonstrated a commitment to continuous improvement by actively seeking out opportunities for process optimization within the Medical Claims Analyst role.
- Provided exceptional customer service, addressing inquiries regarding coverage, benefits, and claims
- Served as an expert resource for colleagues on medical coding systems such as ICD-10, CPT, and HCPCS Level II coding conventions.
- Maintained knowledge of benefits claim processing, claims principles, medical terminology, and procedures and HIPAA regulations.
- Researched and resolved complex medical claims issues to support timely processing. Including adjustments, refund recovery, subrogation, pre-existing condition and fraud investigations.
Education
No Degree - Spanish
Maricopa Community Colleges, Estrella Mountain Community College
Avondale, AZNo Degree -
Chemeketa Community College
Salem, ORHigh School Diploma -
Kingman High School
Kingman, AZSkills
- Claims analysis
- Customer Service
- Time management abilities
- Claims investigation and research
- Performance monitoring
- Verbal and written communication
- Cross-functional team leadership
- Policies and procedures implementation
- Contract review and recommendations
Accomplishments
- Used Microsoft SharePoint to develop departmental sites utilizing lists, libraries and workflows to centralize and organize information used to manage financial, case management, reinsurance, customer service and cost containment functions of the department.
Certification
Associate, Life and Health Claims (ALHC)
Associate, Customer Service (ACS)
Fundamentals of Life and Health Insurance (FLMI -level 1)
Work Availability
monday
tuesday
wednesday
thursday
friday
saturday
sunday
morning
afternoon
evening
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Work Preference
Work Type
Full TimeWork Location
RemoteHybridImportant To Me
Work-life balanceCompany CultureWork from home optionHealthcare benefitsPaid time offFlexible work hoursSoftware
Microsoft Word
Microsoft SharePoint
Microsoft Outlook
Proprietary Claims Adjudication Systems
Interests
Volunteering/fostering - local animal shelter
Affiliations
- HOA President - local homeowner's association
Languages
Spanish
Elementary
Timeline
Claims Manager - International
Ebix Health Administration Exchange, Inc.
08.1997 - Current
Medical Claims Analyst
John Alden Life Insurance
06.1989 - 04.1997
Associate, Life and Health Claims (ALHC)
Associate, Customer Service (ACS)
Fundamentals of Life and Health Insurance (FLMI -level 1)
No Degree - Spanish
Maricopa Community Colleges, Estrella Mountain Community College
No Degree -
Chemeketa Community College
High School Diploma -
Kingman High School
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