Dawna Leamon
North Richland Hills,TX
Summary
Detail-oriented team player with strong organizational skills. Ability to handle multiple projects simultaneously with a high degree of accuracy.
To seek and maintain full-time position that offers professional challenges utilizing interpersonal skills, excellent time management and problem-solving skills.
Successful at reviewing suspicious activities and uncovering fraud. Experienced in meticulously and methodically assessing merchant portfolio batches each day. Excellent reporting and documentation skills.
Organized and dependable candidate successful at managing multiple priorities with a positive attitude. Willingness to take on added responsibilities to meet team goals.
Knowledgeable and dedicated customer service professional with extensive experience in health insurance industry. Solid team player with outgoing, positive demeanor and proven skills in establishing rapport with clients. Motivated to maintain customer satisfaction and contribute to company success. Specialize in quality, speed and process optimization. Articulate, energetic and results-oriented with exemplary passion for developing relationships, cultivating partnerships and growing businesses.
Overview
10
10
years of professional experience
Work History
Quality Assurance Analyst (QA Analyst)
United HealthGroup
11.2016 - 05.2023
- Listen to Customer Service calls to determine if Quality guidelines were followed
- Claims processing
- Medical records review
- Premium handling
- Large claim file audits
- Reviewed premium processing to determine if guidelines were followed by Customer Service Analysts.
- Supported company in maintaining work environment focused on quality, communication, collaboration, integration, and teamwork.
- Mentored and coached team members on QA topics and strategies.
- Participated in requirements and used case reviews.
- Created and achieved product quality objectives and met product specifications.
- Fixed identified issues to increase productivity and boost workflows.
- Assisted teammates in developing skills necessary to grasp application concepts and tool suite.
- Wrote and maintained detailed internal documentation on developed systems.
Claims Risk Analyst
US HealthGroup
09.2015 - 11.2016
- Begin pre-existing investigations on potential Member's wishing to upgrade their benefits
- Review phone logs by Upgrade Analysts to retrieve information regarding medical conditions and physicians seen
- Request claim forms from Members, medical records from physicians and facilities to begin investigations
- Follow up with requests (via phone, fax, US mail) to Members, physicians and facilities
- Determine eligibility of Upgrades
- Forward to Claims Analysts for processing.
- Investigated allegations to check validity and recommend actions to minimize risk.
- Produced and filed reports to inform senior management of current activities and progress with investigations.
Customer Service Analyst
US HealthGroup (assumed By UnitedHealth Group)
02.2013 - 09.2015
- Answer telephone calls from Members, Providers and Agents in regard to coverage, premiums and claims status and processing
- Audit claims processed by claims analysts
- Request check tracers on outstanding claim payments
- Process cancellations on policies (Paid to date and pro-rated)
- Provided primary customer support to internal and external customers.
- Maintained customer satisfaction with forward-thinking strategies focused on addressing customer needs and resolving concerns.
- Answered product and service questions, suggesting other offerings to attract potential customers.
- Answered constant flow of customer calls with minimal wait times.
- Consulted with outside parties to resolve discrepancies and create expert solutions.
- Investigated and resolved customer inquiries and complaints quickly.
- Developed highly empathetic client relationships and earned reputation for exceeding service standard goals.
- Maintained up-to-date knowledge of product and service changes.
- Met customer call guidelines for service levels, handle time and productivity.
- Followed-through on all critical inter-departmental escalations to increase customer retention rates.
- Delivered prompt service to prioritize customer needs.
- Work in a timely and efficient manner to complete telephone calls.
Education
High School Diploma -
Richland High School
North Richland Hills, TXSkills
- Hard working, self-sufficient, highly motivated team player with 32 years in the health insurance industry
- Easily adjusts to changes in workplace environment and procedures
- Proficient in medical terminology, contract language and state mandates
- Processed claims in AS400 and RIMS settings Skilled in Microsoft Word, Microsoft Office and Excel
- Improvement Recommendations
- Deductive Reasoning
- Data Analysis
- Consultative Support
- Quality Processes
- Call Monitoring
- Quality Assurance
- QA Planning
- Issue Resolution
- Process Implementation
- Peer Relationships
- Report Delivery
- Conformance Assessment
- Product Optimization
- Corrective Actions
- Random Sampling
- Atlassian JIRA
- Monitor Quality Control
- Investigation of Claims
- Compile Data
Detailed References
- Deborah Watkins, Policy Owner Services Manager, United Healthcare, Saginaw, TX, watkinsd@ushealthgroup.com, 817-905-6041
- Karen Petite, Policy Owner Services Analyst, United Healthcare, Fort Worth, TX, petitek@ushealthgroup.com, 682-225-5871
- Leahann Britain, Long Term Caretaker, Healing Hands, 3124 Kingsbury Avenue, Richland Hills, TX, 76118, 682-500-4755
Licenses Certificates Training
Medical Terminology
Personal Information
Work Permit: Authorized to work in the US for any employer
Work Availability
monday
tuesday
wednesday
thursday
friday
saturday
sunday
morning
afternoon
evening
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Quote
Far and away the best prize that life offers is the chance to work hard at work worth doing.
Theodore Roosevelt
Timeline
Quality Assurance Analyst (QA Analyst)
United HealthGroup
11.2016 - 05.2023
Claims Risk Analyst
US HealthGroup
09.2015 - 11.2016
Customer Service Analyst
US HealthGroup (assumed By UnitedHealth Group)
02.2013 - 09.2015
High School Diploma -
Richland High School
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