Denise Lomax
Columbus,OH
Summary
Organized and dependable candidate successful at managing multiple priorities with a positive attitude. Willingness to take on added responsibilities to meet team goals.
Overview
25
25
years of professional experience
Work History
Claims Benefit Specialist
CVS Healthcare
12.2016 - Current
- Detail-oriented, quality minded, able to recognize trends and meet expected results.
- Skilled at working independently and collaboratively in team environment.
- Ability to multitask in fast paced environment.
- Review and research resolution of claims payment issues in accordance with claim processing guidelines.
- Maintain quality and productivity standards.
- Use critical thinking to break down problems, evaluate solutions and make decisions.
- Resolved complex claims issues for improved customer satisfaction and reduced claim backlog.
Appeals Specialist
Cigna
05.1999 - 11.2016
- Maintained high levels of accuracy in all written correspondence, ensuring clear communication during appeals process.
- Coordinated directly with specialized case management team for clinical information.
- Research and resolution of all member and provider complaints and appeals to include written correspondence to communicate outcome.
- Acted as departmental resource on appeals matters.
- Managed high-stress situations with professionalism, ensuring that appeals were handled promptly and accurately, even under tight deadlines or heavy caseloads.
- Analyze project and/or individual rework claims for root cause.
- Ensured complaint and appeal turnaround times were met, and responses were compliant with state and regulatory requirements.
- Trained and mentored claim processors - Demonstrated ability to handle multiple assignments competently, accurately and efficiently
- Consistently met performance metrics, demonstrating strong understanding of claims review process and unwavering commitment to achieving positive results for clients.
Education
Some College (No Degree) - Business Management
Columbus State Community College
Columbus, OHSkills
- Claims Processing
- Teamwork and Collaboration
- Data Entry
- Attention to Detail
- Decision-Making
- Customer Service
- Organizing and Prioritizing Work
- Problem Resolution
- Medical Terminology
- Time Management
- Remote Office Availability
Timeline
Claims Benefit Specialist
CVS Healthcare
12.2016 - Current
Appeals Specialist
Cigna
05.1999 - 11.2016
Some College (No Degree) - Business Management
Columbus State Community College