DeVonna Hicks
Lilburn,GA
Summary
Organized and detail-oriented Investigator dedicated to improving efficiency, productivity and profitability through continuous process improvement. Analytical thinker skilled at developing innovative solutions to complex problems.
Overview
10
10
years of professional experience
Work History
Claims Adjuster
State Farm
10.2023 - Current
- Negotiated favorable settlements with claimants, attorneys, and other insurance carriers to minimize financial risk for company.
- Examined claims forms and other records to determine insurance coverage.
- Documented all investigation activity and presented reports to management.
- Verified insurance claims and determined fair amount for settlement.
- Conducted thorough investigations of complex insurance claims, gathering evidence and analyzing relevant documentation.
- Directed claims negotiations within allowable limit of $25,000 and supported successful litigations for advanced issues.
Patient Communication Representative
UCLA Health
03.2020 - 02.2021
- Assisted in development of departmental policies and procedures by providing valuable input based on experience and best practices within patient communication.
- Provided exceptional customer service to patients, resulting in increased patient retention and loyalty.
- Coordinated referral authorizations for specialty services, facilitating timely access to necessary medical care for patients.
- Resolved complex situations with diplomacy and professionalism, leading to satisfactory outcomes for both patients and organization.
Medical Management Specialist
Anthem
02.2018 - 05.2019
- Conducted thorough audits of 50 -100 daily medical records to ensure compliance with legal requirements and industry best practices.
- Established strong relationships with external stakeholders, including insurance companies and regulatory agencies, ensuring smooth operations and compliance with relevant guidelines.
- Identified opportunities for cost savings in healthcare delivery, ultimately contributing to overall organizational profitability.
- Spearheaded implementation of new technologies, leading to more efficient processes and improved patient outcomes.
Utilization Management Coordinator
Aetna
01.2015 - 11.2017
- Reduced hospital readmission rates by 10% through thorough assessment of patient needs, developing appropriate post-discharge plans.
- Enhanced patient care by efficiently coordinating utilization management processes and reviewing medical records for case appropriateness.
- Maintained accurate documentation of all reviews, appeals, and decisions in line with organizational standards and requirements.
- Facilitated effective communication between care teams, patients, and insurance companies, resulting in streamlined care coordination.
Customer Service Advocate
UnitedHealth Care, UnitedHealth Group
01.2014 - 12.2014
- Collaborated with cross-functional teams to address daily up to 65 complex customer issues and improve overall experience.
- Maintained up-to-date knowledge of product and service changes.
- Delivered exceptional customer service to every customer by leveraging extensive knowledge of products and services and creating welcoming, positive experiences.
- Developed highly empathetic client relationships and earned reputation for exceeding service standard goals.
Education
No Degree - Public Administration
Kean University
UnionSkills
- Caseload Management
- Risk Assessment
- Insurance policy coverage knowledge
- Data Analysis
Timeline
Claims Adjuster
State Farm
10.2023 - Current
Patient Communication Representative
UCLA Health
03.2020 - 02.2021
Medical Management Specialist
Anthem
02.2018 - 05.2019
Utilization Management Coordinator
Aetna
01.2015 - 11.2017
Customer Service Advocate
UnitedHealth Care, UnitedHealth Group
01.2014 - 12.2014
No Degree - Public Administration
Kean University