Talented Manager with expert team leadership, planning and organizational skills built during successful career. Smoothly equip employees to independently handle daily functions and meet customer needs. Diligent trainer and mentor with exceptional management abilities and results-driven approach.
Overview
29
29
years of professional experience
Work History
Claims Adjustments Manager
Conduent, Inc
11.2021 - Current
Managed and motivated employees to be productive and engaged in work.
Accomplished multiple tasks within established timeframes.
Enhanced customer satisfaction by resolving disputes promptly, maintaining open lines of communication, and ensuring high-quality service delivery.
Maximized performance by monitoring daily activities and mentoring team members.
Cross-trained existing employees to maximize team agility and performance.
Monitored and analyzed business performance to identify areas of improvement and make necessary adjustments.
Achieved departmental goals by developing and executing strategic plans and performance metrics.
Developed and implemented business strategies to achieve business goals and stay competitive.
Reduced operational costs through comprehensive process improvement initiatives and resource management.
Facilitated successful cross-functional collaborations for the completion of key projects, fostering strong working relationships among team members.
Streamlined workflows by identifying bottlenecks in existing systems and proactively addressing these challenges through appropriate solutions implementation.
Maintained positive customer relations by addressing problems head-on and implementing successful corrective actions.
Established team priorities, maintained schedules and monitored performance.
Defined clear targets and objectives and communicated to other team members.
Used industry expertise, customer service skills and analytical nature to resolve customer concerns and promote loyalty.
Assisted in organizing and overseeing assignments to drive operational excellence.
Developed detailed plans based on broad guidance and direction.
Leveraged data and analytics to make informed decisions and drive business improvements.
Medical Claims Team Lead
Conduent, Inc
06.2015 - 11.2021
Trained new team members by relaying information on company procedures and safety requirements.
Promoted a positive work environment by fostering teamwork, open communication, and employee recognition initiatives.
Served as a role model for the team by demonstrating commitment to excellence, professionalism, and adherence to company values at all times.
Coached team members in techniques necessary to complete job tasks.
Enhanced overall team performance by providing regular coaching, feedback, and skill development opportunities.
Collaborated with other department leads to streamline workflows, improve interdepartmental coordination, and achieve business goals collectively.
Increased customer satisfaction by ensuring timely completion of projects and adherence to high-quality standards.
Influenced positive change within the organization through strategic thinking, innovation, problem-solving abilities, and consistent leadership style.
Nurtured long-term partnerships with clients by understanding their needs accurately, delivering projects on time, and providing exceptional customer support.
Supervised team members to confirm compliance with set procedures and quality requirements.
Mentored and guided employees to foster proper completion of assigned duties.
Medical Claims Processor
Conduent Business Solutions
09.2012 - 06.2015
Processed high volumes of medical claims accurately and efficiently under tight deadlines, ensuring prompt payment for services rendered.
Researched and resolved complex medical claims issues to support timely processing.
Maintained knowledge of benefits claim processing, claims principles, medical terminology, and procedures and HIPAA regulations.
Paid or denied medical claims based upon established claims processing criteria.
Evaluated medical claims for accuracy and completeness and researched missing data.
Reviewed provider coding information to report services and verify correctness.
Reduced errors in claims submissions through meticulous attention to detail and thorough review processes.
Maintained a thorough understanding of the intricacies involved in processing medical claims for diverse healthcare specialties, enabling accurate and efficient claim adjudication.
Ensured compliance with all applicable regulations by maintaining strict adherence to HIPAA guidelines and company protocols when handling sensitive patient information.
Contributed to positive team morale through active participation in department meetings, offering constructive feedback, and supporting colleagues when needed.
Assisted in the development of training materials for new hires, improving overall team knowledge and productivity.
Provided exceptional support during audits by supplying detailed records of claim transactions as needed, ensuring full transparency into department operations.
Identified opportunities for process improvements within the claims department, leading to increased overall efficiency and reduced costs associated with claim reworkings.
Mastered various proprietary claim processing systems quickly allowing seamless adaptation to new technology initiatives within the organization.
Handled escalated claims-related issues professionally, working diligently towards resolution while maintaining strong relationships with both clients and providers alike.
Maintained strong knowledge of basic medical terminology to better understand services and procedures.
Medical Claims Processor
Aetna
04.1995 - 01.2011
Processed high volumes of medical claims accurately and efficiently under tight deadlines, ensuring prompt payment for services rendered.
Researched and resolved complex medical claims issues to support timely processing.
Maintained knowledge of benefits claim processing, claims principles, medical terminology, and procedures and HIPAA regulations.
Managed large volume of medical claims on daily basis.
Monitored and updated claims status in claims processing system.
Paid or denied medical claims based upon established claims processing criteria.
Evaluated medical claims for accuracy and completeness and researched missing data.
Reduced errors in claims submissions through meticulous attention to detail and thorough review processes.
Maintained a thorough understanding of the intricacies involved in processing medical claims for diverse healthcare specialties, enabling accurate and efficient claim adjudication.
Ensured compliance with all applicable regulations by maintaining strict adherence to HIPAA guidelines and company protocols when handling sensitive patient information.
Contributed to positive team morale through active participation in department meetings, offering constructive feedback, and supporting colleagues when needed.